Clinical Study On Yishen Qingli Decoction In Treating The Kidney Deficiency And Dampness Heat Syndrome Of Chronic Glomerulonephritis And Regulation Of NGAL And Inflammatory Factors

Primary chronic glomerulonephritis(PCGN), short for chronic nephritis, with a variety of pathological manifestation, which can cause a gradually decline of renal function, is the main cause of end-stage renal disease (ESRD) in China. At present, modern medical considers that the occurrence and progression of PCGN is closely related to the inflammatory lesions mediated by immune response. According to its characteristics of the pathogenesis and clinical manifestations, traditional medical reckons PCGN as one symptom of the "pain", "kidney wind", "edema" and "hematuria". PCGN manifests more in the syndrome of deficiency in origin and excess in superficiality, in which the kidney deficiency and dampness heat is the common syndrome type. Many scholars have found that there is a link between the kidney deficiency and dampness heat syndrome of PCGN and renal injury caused by immune inflammatory reaction. The Yi Shen Qing Li recipe is frequently used by my tutor in treating the kidney deficiency and dampness heat syndrome of PCGN for many years. It mainly compromises astragalus membranaceus, atractylodes, ducommia ulmoides, Pyrrosia leaf, oriental waterplantain rhizome and oldenlandia, etc. which is effective in the treatment of tonifying the kidney and invigorating Qi, clearing heat and eliminating dampness. Due to its significant curative effect, the hospital intends to make it an internal preparation in clinical treatment. This study is based on the former research of pharmacology and toxicology and part of the clinical research, further explore the mechanism of this recipe treating the kidney deficiency and dampness heat syndrome of PCGN by regulating immune therapy,observes the long-term curative effect, to improve the evaluation of clinical curative effect; in order to provide clinical and theoretical basis for the development of hospital preparations. The main contents are as follows:First, The clinical research of the Yi Shen Qing Li recipe in treating the kidney deficiency and dampness heat syndrome of PCGN and the role of regulating NGAL and inflammatory factorTake 30 cases of patients who meet the inclusion criteria was given the basic treatment of western medicine with the Yi Shen Qing Li recipe for 1 month as the treatment group. Observe the patients’changes of symptoms signs and 24h urine protein quantitative, renal function; neutrophil gelati-nase-associated lipocalin(NGAL), interleukin-6(IL-6), tumor necrosis factor-a(TNF-a), interleukin-10 (IL-10) and nuclear transcription factor (NF-κB) before and after treatment. Take 30 cases of healthy persons as the normal control group. The normal group’s NGAL, IL-6, TNF-a, IL-10 and NF-κB were recorded as baseline. The results show that: (1) the treatment with Yi Shen Qing Li recipe can effectively improve the clinical symptoms, reduces the urinary protein, decrease Scr、BUN level, improve renal function. The clinical efficiency and TCM syndrome efficiency were 93.33% and 96.67% respectively; (2) the treatment which uses the Yi Shen Qing Li recipe can significantly reduce blood NGAL, IL-6, TNF-α, NF-κB levels, elevated levels of blood IL-10; (3) the blood NGAL and IL-6 changes were positively correlated. Here comes the conclusion:the clinical curative effect about the kidney deficiency and dampness heat syndrome of PCGN is remarkable by the basic treatment of western medicine with Yi Shen Qing Li recipe. Its mechanism may be related to the inhibition of the NF-κB signaling pathway, which regulates the expression of IL-6, TNF-a and IL-10. Meanwhile, the recipe can reduce the effect of immune damage in renal tissue by the way of inhibiting the expression about TNF-a, IL-6, and promoting the secretion of IL-10 directly. These two synergistic effects may become the therapeutic mechanism of this recipe. Since the secretion level of NGAL is closely related to the expression of IL-6, we suggest that the formation of PCGN renal damage is related to the abnormal expression of NGAL. This recipe may also improve the immune inflammatory injury of PCGN through inhibiting the expression of NGAL.Second, the long-term curative effect and observation of the Yi Shen Qing Li recipe in treating the kidney deficiency and dampness heat syndrome of PCGNChoose another 21 patients who meet the inclusion criteria as the long-term treatment group. Give the basic treatment of western medicine with Yi Shen Qing Li recipe and conduct a long-term curative effect of 24 month follow-up. Record the changes of symptoms、signs and 24h urine protein quantitative, renal function before and after treatment every 6 month. Evaluate the clinical effect by comparing symptoms、signs and related laboratory indexes before and after the treatment and each period of time after treatment. The results show that:(1) the total effective rate about clinical efficacy and TCM syndromes of 6 months,12 months,18 months, 24 months in long-term treatment group are 80.95%,90.48%; 85.71%,95.23%; 90.48%,95.23%; 90.48% and 95.23% respectively; (2) the urinary protein, serum creatinine level is decreased significantly after the treatment, and the long-term effect is stable; (3)the BUN and Ccr level are stable after treatment, with no development tendency. The conclusion is:the long term clinical effect about treatment PCGN by given the basic treatment of western medicine with the use of the Yi Shen Qing Li recipe is stable, it can significantly reduce the protein urine, Scr level, and alleviate the progress of renal function for a long period.