| Objective To investigate the characteristics of TCM syndromes of IgA nephrology with secondary segmental glomerulosclerosis,and to understand the correlation between efficacy and TCM syndrome,clinical and pathological.Methods 103 patients with Lee III-IV grade of primary IgA nephropathy diagnosed by renal biopsy in Hangzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2015 were treated with traditional Chinese medicine benefiting kidney and promoting blood circulation combined with glucocorticoids therapy.The Chinese medicine benefiting kidney and promoting blood circulation formula is composed of Radix astragali,Angelica sinensis,Radix rehmannia,Hangzhou white peony,Ligusticum chuanxiong hort,Peach kernel,Herba centellae,etc.Patients of 24 hours proteinuria quantitative ≥ 3.5g toke prednisone / prednisolone orally at a dosage of 0.8-1.0mg/kg per day and the other toke prednisone / prednisolone orally at a dosage of 0.4-0.6mg/kg per day,with drug reduction after 2 months.Course of treatment for all cases ranged from 10 to 12 months.For at least two years of study,follow-up,record the patient’s clinical symptoms and laboratory tests,and re-evaluate the pathological results,evaluation of efficacy and safety;and to analyze the relationship between efficacy and TCM syndrome,clinical and pathological.Results(1)Among the 103 patients who met the inclusion criteria,63 cases(61.2%)of Lee classificationⅢ,40 cases(38.8%)of Lee classification Ⅳ,51 males and 52 females had an average age of 36.1 ± 12.9 years for puncture of kidney,an average of 1.97 ± 2.12 grams of urinary protein and a serum creatinine level of 90.9 ± 39.0umol / l,glomerular filtration rate(e GFR)83.7 ± 31.8ml / min / 1.73m2,the average duration of 12 months,followed up for 24 months.(2)After 2 years of follow-up,the complete remission rate was 52.9%(54/102)and the total effective rate(complete remission + effective rate)was 82.4%(84/102)by treating of Chinese medicine benefiting kidney and promoting blood circulation combined with hormone therapy;24-hour urine protein,urinary red blood cell count and serum creatinine decreased after treatment,the levels of serum albumin,glomerular filtration rate,and hemoglobin were significantly higher than those before treatment(p <0.01).Before and after treatment,urea nitrogen,serum uric acid,platelet difference was not statistically significant(p> 0.05);(3)The baseline serum creatinine of 24 M total effective group was significantly lower than that of non-effective group,the difference was statistically significant(p <0.01).(4)The total effective Katafuchi’s integral and Andreoli’s chronic integral of 6M,12 M,18M and 24 M patients were significantly lower than those of non-effective patients(p <0.05)Andreoli’s active integral of the total effective patients at 24 M was significantly lower than that of non-effective patients(p <0.01).Lee Class III was significantly more effective than Lee class IV(p <0.05).(5)The TCM syndrome scores were significantly improved before and after treatment(p <0.01);The curative effect evaluation of Chinese medicine showed that 8 cases were completely relieved at 12 M,24 cases markedly effective,12 cases completely relieved at 24 M and 32 cases markedly effective;(6)During the follow-up period,one patient entered the end-point event,which showed that the patient entered end stage renal disease and was treated with peritoneal dialysis.(7)Safety: 9 cases(8.7%)had impaired glucose tolerance / impaired fasting glucose after 2 years of follow-up,2 cases(1.9%)had pulmonary infection,4 cases(3.9%)had obvious increase in blood pressure,6 cases(5.8%)of gastrointestinal symptoms,which can be improved after symptomatic treatment,and no serious adverse events occurred.Conclusion 1.Chinese medicine benefiting kidney and promoting blood circulation combined with hormone therapy can stabilize and improve the renal function of renal pathology in patients with primary IgA nephropathy,reduce its proteinuria,and has good safety;2.For the mild pathology(low of Katafuchi’s integral and Andreoli’s chronic integral),early treatment is more likely to clinical benefit,the clinical benefit can be sustained to 2 years or even longer;3.Kidney deficiency syndrome,blood stasis syndrome,rheumatic card syndrome-related indicators have improved to varying degrees after treatment;4.Professor Wang Yongjun syndrome differentiation of traditional Chinese medicine treatment of IgAN has a good clinical value,it is worth promoting. |
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