| ObjectiveThis study explored the clinical efficacy and safety of Kunxian Capsules combined with immunosuppressive agents in the treatment of idiopathic membranous nephropathy by propensity score method,so as to provide certain reference basis for the treatment of idiopathic membranous nephropathy.MethodsThis study was retrospectively analyzed.108 patients with idiopathic membranous nephropathy in the Department of Nephrology of Guangdong Province Traditional Chinese Medical Hospital from January 2012 to November 2019 who were treated with immunosuppressants combined with glucocorticoid for 3-6 months were included.The urine protein in patients with idiopathic membranous nephropathy was still greater than 3.5 g/d.They were divided into two groups according to whether Kunxian capsule was used in the follow-up half a year.The observation group was 35 patients who received Kunxian capsule combined with immunosuppressant regimen,and the control group was 73 patients treated with immunosuppressant regimen.According to the baseline levels at the time of inclusion such as age,sex,serum creatinine,serum albumin and urinary protein,complications,the two groups were matched by propensity score method with a ratio of 1:1,and the observation time was 6 months.Changes in laboratory indicators such as urinary protein,serum albumin,serum creatinine were compared between the two groups before and after treatment.The efficacy and safety were analyzed.Results(1)Baseline characteristics of the two groups at the time of inclusion:the urinary protein of the observation group was less than that of the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in age,sex,serum creatinine,serum albumin,complications between the two groups(P>0.05).Propensity score matching was used to control the confounding factors between groups.(2)After propensity score matching,there were 35 patients in the observation group,including 23 males and 12 females,with an average age of 57(50,63)years.There were 17 patients with hypertension and 5 patients with diabetes.The average serum creatinine was 85(69,106)μmol/L,the average serum albumin was 30.96±2.80g/L,and the average urinary protein was 3781(3568,4119)mg/d.There were 35 patients in the control group,including 22 males and 13 females,with an average age of 58(54,63)years.There were 19 patients with hypertension and 5 patients with diabetes.The average serum creatinine was 83(68,95)μ mol/L,the average serum albumin was 29.91±3.18g/L,and the average urinary protein was 3988(3682,4252)mg/d.There was no statistically significant difference in baseline levels between the two groups(P>0.05).The two groups were comparable.(3)After 3 months of treatment,the urinary protein of the observation group was 980(400,2320)mg/d,which was lower than that before treatment,the difference was statistically significant(P<0.05).The serum albumin was 30.30±2.61g/L,the serum creatinine was 83(71,100)μmol/L,there was no significant difference compared with that before treatment(P>0.05),the total remission rate was 74.28%.The urinary protein of the control group was 1923(1142,2993)mg/d,and the serum albumin was 31.62±3.48g/L,which was improved compared with that before treatment,and the difference was statistically significant(P<0.05),the serum creatinine was 80(69,96)μ mol/L,which had no statistically significant difference compared with that before treatment(P>0.05),the total remission rate is 51.43%.The degree of urine protein decrease in the observation group was more significant than that in the control group(P<0.05),and there was no significant difference in serum albumin and serum creatinine between the two groups(P>0.05).The total remission rate of the observation group was significantly higher than that of the control group,which was statistically significant(P<0.05).(4)After 6 months of treatment,the urinary protein of the observation group was 548(299,950)mg/d which was significantly lower than that before treatment,the difference was statistically signifcant(P<0.05),the serum albumin was 31.54 ± 3.07g/L,the serum creatinine was 83(69,105)μ mol/L,there was no statistical difference compared with that before treatment(P>0.05),the total remission rate was 82.86%.In the control group,urinary protein was 1316(900,1944)mg/d,and the serum albumin was 33.95±3.74 g/L,which was improved compared with that before treatment,and the difference was statistically significant(P<0.05),the serum creatinine was 82(71,93)μmol/L,there was no significant difference from that before treatment(P>0.05),and the total remission rate was 57.14%.The decrease in urine protein in the observation group was more significant than that in the control group,and the increase in serum albumin in the control group was more significant than that in the observation group(P<0.05),and there was no statistical difference in serum creatinine between the two groups(P>0.05).The total remission rate of the observation group was significantly higher than that of the control group,which was statistically significant(P<0.05).(5)Safety indicators:There was no statistically significant difference between the observation group and the control group in ALT,AST,WBC,Hb,and PLT at the time of inclusion(P>0.05).Three months after treatment,the observation group had no significant changes in ALT,AST,WBC,Hb,and PLT compared with those before treatment(P>0.05).The control group had no significant changes in ALT,AST,WBC,Hb compared with those before treatment(P>0.05),and PLT was lower than that before treatment(P<0.05).The difference in ALT,AST,WBC,Hb,PLT between the two groups was not statistically significant(P>0.05).Six months after treatment,the observation group had no significant changes in ALT,AST,WBC,Hb,and PLT compared with those before treatment(P>0.05).The control group had no significant changes in ALT,AST,WBC,Hb compared with those before treatment(P>0.05),and PLT decreased compared with that before treatment(P<0.05).The difference in ALT,AST,WBC,Hb between the two groups was not statistically significant(P>0.05).PLT of the control group was lower than that of the observation group,which was statistically significant(P<0.05).Conclusion(1)Kunxian capsule combined with immunosuppressive agents can reduce urine protein and stabilize the serum creatinine level in patients with idiopathic membranous nephropathy,and has a high clinical remission rate.Compared with the control group,the observation group has more obvious effect of reducing urinary protein and the clinical remission rate is higher.(2)Kunxian capsule is relatively safe without obvious hepatorenal toxicity and myelosuppression. |
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