| Objective: to analyze the clinical data of 90 patients with stage I and II idiopathic membranous nephropathy(IMN)retrospectively,summarize the distribution of TCM syndrome types of IMN patients,the medication rules of TCM treatment of IMN and the use of immunosuppressants in the nephrotic diagnosis and treatment center of Tianjin Academy of traditional Chinese medicine,and explore the risk factors of IMN combined with hypercoagulable state,Objective to summarize the treatment characteristics of idiopathic membranous nephropathy(IMN)in our center,and to provide reference for further development of treatment plan.Methods: from January 2018 to December 2020,90 patients with stage I and II IMN were selected.The clinical symptoms,signs,laboratory indexes(24-hour urine protein,plasma albumin,total protein,blood routine,total cholesterol,triglyceride,low density lipoprotein,transaminase,serum creatinine,fibrinogen concentration,D-dimer,etc.)were collected before and after 1 month treatment.According to the four diagnostic data of patients,according to the diagnostic criteria of TCM syndrome in the guiding principles for clinical research of new traditional Chinese Medicine issued in 2002,the patients were divided into TCM syndrome types.The data were input into excel,spss25.0 software was used,binary logistic regression was used to analyze the risk factors of IMN combined with hypercoagulable state,and systematic cluster analysis was used to analyze the high-frequency drugs of traditional Chinese medicine in the treatment of IMN.Result:1.TCM syndrome differentiation before treatment: 45 cases of spleen and kidney qi deficiency syndrome(50.00%),13 cases of spleen and kidney yang deficiency syndrome(14.44%),13 cases of liver and kidney yin deficiency syndrome(14.44%),12 cases of Qi and yin deficiency syndrome(13.33%),7 cases of lung and kidney qi deficiency syndrome(7.79%).In standard excess syndrome,82 cases(91.11%)were blood stasis syndrome,50cases(55.56%)were water dampness syndrome,29 cases(32.22%)were damp heat syndrome,and 9 cases(10%)were dampness turbidity syndrome.There are multiple syndrome coexisting in standard excess syndrome: 45 cases(50.00%)of blood stasis and dampness syndrome,27 cases(30.00%)of blood stasis and dampness heat syndrome,90cases(100.00%)of this deficiency syndrome and standard excess syndrome.It can be seen that the deficiency and excess syndrome of this disease are combined.The deficiency of spleen and kidney qi is the main syndrome of this deficiency syndrome,and the blood stasis syndrome is the main syndrome of standard excess syndrome,25 cases(27.78%)of which are spleen and kidney qi deficiency and blood stasis and dampness syndrome There were 12 cases(13.33%)of spleen kidney qi deficiency and blood stasis damp heat syndrome.2.Use of immunosuppressants: all patients were treated with traditional Chinese medicine,and basic treatment(ACEI / ARB,antihypertensive,hypoglycemic,lipid-lowering,anticoagulant,etc.)was used according to the actual situation of patients.There were 6 cases(6.67%)using traditional Chinese medicine alone and 84 cases(93.33%)using traditional Chinese medicine plus immunosuppressant.Of the 84 patients,29(34.52%)were treated with traditional Chinese medicine plus tripterygium glycosides tablets,9(10.72%)with traditional Chinese medicine plus tacrolimus,8(9.52%)with traditional Chinese medicine plus hormone,2(2.38%)with traditional Chinese medicine plus leflunomide,3(3.57%)with traditional Chinese medicine plus total glucosides of paeony,18(21.43%)with traditional Chinese medicine plus hormone plus tripterygium glycosides tablets,6(7.15%)with traditional Chinese medicine plus hormone plus tacrolimus,and 7(8.33%)with traditional Chinese medicine plus hormone plus cyclophosphamide,1 case(1.19%)was treated with traditional Chinese medicine + hormone + leflunomide,and 1 case(1.19%)was treated with traditional Chinese medicine + hormone + cyclosporine.Among 90 patients with IMN,47(52.22%)were treated with Tripterygium Glycosides tablets.The dosage of tripterygium glycosides tablets was 40 mg / D(31.91%)and 60 mg / D(65.96%).The dosage of corticosteroids(prednisone acetate or methylprednisolone)was 45.56%.The dosage of tripterygium glycosides tablets was ≤ 4 tablets / day(43.90%)and 5-10 tablets / day(36.59%).3.Use of traditional Chinese medicine:(1)frequency analysis of traditional Chinese medicine: a total of 165 drugs were used in 90 newly diagnosed prescriptions of 90 patients,with a total frequency of 1538 times.According to excel frequency analysis,there were 24 drugs with frequency more than 20 times.According to the frequency,they were Astragalus membranaceus,Salvia miltiorrhiza,chuanxiong,Atractylodes macrocephala,Smilax glabra,Smilax glabra,Rosa laevigata,Schisandra chinensis,Euryale ferox seed,white gourd skin,mulberry white skin,Smilax glabra,angelica,Sparganium,rhubarb charcoal,Cimicifuga,raspberry,Pericarpium,Psoralea,Patrinia,Dendrobium Ramulus Cinnamomi,Fructus aurantii.Among them,radix astragali(100.00%),Radix Salviae Miltiorrhizae(82.22%),Rhizoma Chuanxiong(80.00%),Rhizoma Atractylodis Macrocephalae(80.00%)and Rhizoma Smilacis(56.67%)were used more than or equal to 50.0%(2)The commonly used drugs in the treatment of IMN in our center were tonifying deficiency drugs(23.67%),promoting blood circulation and removing blood stasis drugs(15.54%),diuretic and dampness drugs(12.55%),astringent drugs(10.47%)and antipyretic drugs(9.69%)(3)Cluster analysis: the 24high-frequency drugs with frequency more than 20 times can be clustered into 6 categories.The first category is Salvia miltiorrhiza,Ligusticum chuanxiong,Smilax glabra,Amomum villosum and Sparganium;The second category: Schisandra,Dendrobium,Psoralea,Cimicifuga;The third category: white gourd skin,Poria cocos skin,mulberry white skin,big belly skin;The fourth category: Rosa laevigata,Euryale ferox and raspberry;The fifth category: rhubarb charcoal and Fructus aurantii;The sixth category: Angelica sinensis and Ramulus Cinnamomi.Astragalus membranaceus,Atractylodes macrocephala,Poria cocos and Patrinia Patrinia are widely used in many prescriptions,but they do not exist alone with specific traditional Chinese medicine.4.Risk factors of IMN combined with hypercoagulable state: 90 cases of IMN patients were analyzed by univariate analysis,and the factors such as gender,age,complications,use of glucocorticoid and various laboratory indexes were analyzed respectively to see whether there were statistical differences with patients with hypercoagulable state.Multivariate logistic regression analysis showed that fibrinogen(or = 6.752,95% CI = 1.510-30.185,P =0.012)and plasma albumin(or = 0.769,95% CI = 0.626-0.946,P = 0.013)were independent risk factors for hypercoagulable state in IMN patients.Conclusion:1.The TCM syndrome types of IMN patients are both deficiency and excess.The deficiency syndrome is mainly spleen and kidney qi deficiency syndrome,and the standard excess syndrome is mainly blood stasis syndrome.The common syndrome types are spleen and kidney qi deficiency and blood stasis dampness syndrome,spleen and kidney qi deficiency and blood stasis dampness heat syndrome.2.Traditional Chinese medicine combined with immunosuppressant was used in the treatment of IMN in our center.The immunosuppressant was mainly tripterygium glycosides tablets,and the hormone was mainly used in small and medium doses;Traditional Chinese medicine mainly includes tonifying deficiency drugs,promoting blood circulation and removing blood stasis drugs,diuresis and dampness drugs,astringent drugs and heat clearing drugs.Astragalus membranaceus,Salvia miltiorrhiza,Ligusticum chuanxiong,Atractylodes macrocephala Koidz and Smilax glabra Koidz are widely used to strengthen spleen and kidney,promote blood circulation and remove blood stasis,and clear dampness and heat.3.The risk factors of IMN with hypercoagulable state are plasma albumin and fibrinogen. |
PDF Full Text Request