| Purpose: To evaluate the efficacy and safety of tripterygium wilfordii polyglycoside tablets in the treatment of idiopathic membranous nephropathy.Method:Sixty-three patients with idiopathic membranous nephropathy were definitely diagnosed by pathological biopsy of menstruation and kidney from January 2017 to December 2018 at the outpatient department of nephrology of the affiliated hospital of changchun university of traditional Chinese medicine and the outpatient department of nephrology of the second hospital of jilin university.Patients in the treatment group were treated with tripterygium wilfordii polyglycoside tablets at 1mg/kg/d,Take it after three meals,Observe treatment for 12 weeks.Oral administration of benazepril hydrochloride tablets to the control group(maintaining the maximum dose under the patient's blood pressure tolerance).The age,sex,pathological stage and syndrome differentiation of the patients were analyzed and summarized;The 24-hour urine protein quantification and TCM syndrome changes were detected before and after treatment,Explore its effectiveness;The safety indexes including blood routine,urine routine,liver function and kidney function were tested,To further verify its security.Result:1.The general situation:The ratio of male to female was 1.10 to 1 in 63 patients with idiopathic membranous nephropathy,There are more cases in men.The age of onset was50-59 years,A total of 31 cases of,Accounted for 49.21%;In TCM syndrome differentiation,spleen-kidney Yang deficiency syndrome is the main syndrome,A total of 38 cases of,Accounted for 60.32%;Concurrently card with damp heat card give priority to,A total of33 cases of,Accounted for 52.38%;Stage II membranous nephropathy was the most common pathological stage,A total of 32 cases,accounting for 50.79%.2.After treatment:4(11.43%)patients in the TWHF group had complete remission,23(65.71%)had partial remission,6(17.14%)had no response,and 2(17.14%)patients in the TWHF group stopped taking medicine due to menstrual disorder,with a total effective rate of 77.14%.In the western medicine group,2 patients had complete remission(7.14%),18 patients had partial remission(64.28%),7 patients had no response(25.0%),and 1patient had fallen off due to poor compliance,with a total effective rate of 71.42%;TCM syndrome evaluation after treatment,There were 5 cases of significant effect(14.28%),24 cases of effective effect(68.57%),3 cases of ineffective effect(8.57%),1 case of cured effect(2.86%)and 2 cases of shedding effect(85.71%)in the tripterygium wilfordii group;In the western medicine group,there were 3 cases(10.71%)of significant effect,15cases(53.57%)of effective effect,1 case(3.57%)of ineffective effect,0 cases(0%)of recovery,and 1 case of shedding,with a total effective rate of 64.28%.3.Laboratory examination:The difference of 24 h urine protein before and after quantitative treatment was statistically significant(P < 0.05),This indicated that both tripterygium wilfordii group and western medicine group could effectively reduce urinary protein,The rate of decreasing urine protein in tripterygium wilfordii group was slower than that in western medicine group,However,after 12 weeks of treatment,the efficacy of tripterygium glycosides tablets group and western medicine group in reducing proteinuria could reach the same baseline level;The differences of serum total protein and serum albumin before and after treatment were statistically significant(P < 0.05),These results indicated that both tripterygium wilfordii group and western medicine group could increase the content of serum albumin and serum albumin,Compared with western medicine group,the rate of serum protein increase in tripterygium wilfordii polyglycoside tablets group was slower,but statistically significant(P< 0.05);After treatment of triglyceride(TG)and total cholesterol(TCHO)have declined,according to modern clinical studies have shown that tripterygium wilfordii without fall hematic fat action,but hyperlipidemia is one of the clinical symptoms of idiopathic membranous nephropathy,especially more closely relationship with total cholesterol,so with the improvement of disease,with the decrease of blood fat also and tripterygium wilfordii group in the process of treatment,blood lipids have a downward trend,of which the most total cholesterol decreased significantly,but the TG and TCHO change difference no statistical significance(P<0.05),blood lipid drops may be associated with IMN got better,no obvious relation with tripterygium wilfordii).There wasno significant difference in liver function,kidney function,urine routine and blood routine before and after treatment(P > 0.05).There are 2 cases of patients during treatment to observe the different degree of liver function is abnormal,WBC decline,1 patients with oral drug,to protect liver medicine and white blood cell in tripterygium wilfordii)after halving the amount back to normal,2 cases of gastrointestinal symptoms appear,not intervention,alleviate by oneself,2 cases of female menstrual disorder patients,patients to stop using tripterygium wilfordii glycosides tablets.During the treatment,the patient had different degrees of adverse reactions,but no acute liver damage,kidney damage and blood system diseases.Therefore,tripterygium wilfordii polyglycosides tablets have certain side effects,but the safety is relatively high.Conclusion: Tripterygium wilfordii polyglycoside tablets can significantly reduce the urine protein in patients with membranous nephropathy,and has good safety. |
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