| Objective:Intervention in children with frequent relapse nephrotic syndrome(FRNS)by treatment of decoction shenkangling by tonifying the kidney and promoting blood circulation,by observing the change of neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule 1(KIM-1)and Interleukin 18(IL-18)before and after intervening FRNS kids,in order to explain pathogenesis better of FRNS and the mechanism of Chinese Medicine ShenKangling,search the biological markers for early renal damage,improve the clinical efficacy of PNS.Methods:40 children patients with FRNS(Simple PNS)from Traditional Chinese Medical College of Fujian and Fuzhou General Hospital of Nanjing Military Region during 2016 years were randomly divided into 2 groups,20 cases in treating group treated by an integrated therapy with Western and Chinese Medicines(groupA)and 20 cases in controlling group treated only by western medicine(groupB).20 healthy cases served as healthy control group(group C).To observe the changes of urine NGAL,KIM-1 and IL-18 in two groups before and after treatment for 4 weeks and after 12 weeks.Statistical analysis was performed by SPSS 20.0 system software.Results:①Before treatment,relative to the group C,the group A and group B had significantly increased the level of urine NGAL,KIM-1 and IL-18(P<0.01),there was no significant difference in the levels of urinary NGAL,KIM-1,IL-18,alpha 1 microglobulin and serum protein,cholesterol,triglyceride and creatinine between the two groups of AB(P>0.05);②After 4 weeks of treatment,compared with before treatment,the levels of NGAL,KIM-1,IL-18 and alpha 1 microglobulin in the urine of A and B group were significantly lower(P<0.01),serum albumin increased significantly(P<0.01),serum creatinine was no significant change(P>0.05),Serum cholesterol and triglyceride decreased in group A(P<0.01 and P<0.05),there was no significant difference in B group(P>0.05);Comparison between A and B group,the urine KIM-1 level in group A was significantly lower than group B(P<0.01),urinary NGAL levels were significantly higher than group B(P<0.01),there was no significant difference in the levels of urinary IL-18 and alpha 1 microglobulin in A and B groups(P>0.05),the levels of cholesterol and triglyceride in A group were significantly lower than group B(P<0.05),the serum protein level of A group was significantly higher than group B(P<0.05),there was no significant difference in serum creatinine between the two groups of A and B(P>0.05).③After 12 weeks of treatment,compared with before treatment,A and B two groups of urine NGAL,KIM-1,IL-18,alpha 1 microglobulin,serum cholesterol and triglyceride levels were significantly decreased(P<0.01),serum albumin increased significantly(P<0.01),there was no significant change in serum creatinine(P>0.05);Compared with 4 weeks after treatment,urinary NGAL levels in group A were significantly reduced(P<0.01),there was no significant difference in the B groups(P>0.05),the levels of urinary KIM-1,IL-18,alpha 1 microglobulin,serum cholesterol and triglyceride were significantly decreased(P<0.01,P<0.01,P<0.01,P<0.05,P<0.05),serum albumin increased significantly(P<0.01),there was no significant change in serum creatinine(P>0.05);Comparison between A and B group,there was no significant difference in the levels of urinary NGAL,KIM-1,IL-18,alpha 1 microglobulin and serum creatinine(P>0.05),the serum protein level of A group was significantly higher than B group(P<0.05),the levels of cholesterol and triglyceride in A group were significantly decreased than B group(P<0.05 and P<0.01).④The area under the ROC curve of urine NGAL,KIM-1 and IL-18 were 0.893,0.886,and 0.837 respectively,the best critical points were 84.78ng/ml,8.01 ng/ml,212.56pg/ml respectively,the sensitivity was 87%,74%and 87%,and the specificity was 82%,91%,and 73%,respectively.Conclusions:①The levels of NGAL,KIM-1 and IL-18 are abnormal in FRNS urine detection,it just illustrates that NGAL,KIM-1 and IL-18 take part in pathogenesis in FRNS.②After the treatment of Chinese Medicine ShenKangling,the level of KIM-1 decreased significantly,after 4 weeks treatment,the treatment group was lower than the control group,traditional Chinese medicine may have a certain effect on reducing urine NGAL and IL-18 levels,traditional Chinese medicine combined with western medicine treatment may help shorten the course of renal tubular injury.③The combination of traditional Chinese medicine and Western medicine is superior to simple western medicine group in improving serum albumin,lowering cholesterol and triglyceride,the traditional Chinese medicine can improve the body of hypercoagulability and high fat state,improve the clinical efficacy.④Urine NGAL,KIM-1,IL-18 change earlier than serum creatinine,urinary NGAL,KIM-1,IL-18 can be used as sensitive biomarkers for early renal tubular damage,and objective indexes for clinical treatment and prognosis of FRNS. |
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