Clinical Study Of Simiao Sijun Decoction Combined With Tripterygium Wilfordii Polyglycoside Tablets In The Treatment Of Idiopathic Membranous Nephropathy

Objective:To observe the clinical efficacy and safety of Simiao Sijun Decoction combined with Tripterygium wilforia polyglycosides tablets in the treatment of Idiopathic membranous nephropathy（IMN）patients with damp heat accumulation and spleen deficiency type,this study explored new ideas for clinical treatment of IMN.Methods:Patients admitted to the outpatient department and ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from November 2020 to June 2022 who met the inclusion criteria of IMN damp-heat accumulation combined with spleen deficiency were collected and randomly divided into experimental group and control group by random number table method.Both groups were given basic Western medicine treatment and tacrolimus capsules,the experimental group was given Simiao Sijun decoction combined with Tripterygium wilfordii polyglycoside tablets,the control group was given Huang Kui capsule combined with prednisone acetate tablets,observation for 6 months.The 24 h urinary protein quantity,serum albumin,anti-phospholipase A2receptor antibody,serum creatinine,urea nitrogen,cystatin C,serum retinol-binding protein,urinaryβ₂ microglobulin,triglyceride,total cholesterol,low density lipoprotein and safety indexes of the two groups were collected before and after treatment,3 months and 6 months,as well as the TCM syndrome scores before and after treatment.Statistical analysis was used to compare the therapeutic effect between the two groups.Results:1.A total of 67 patients completed the experiment in this study,with 34 patients in the control group and 33 patients in the experimental group.Before treatment,there were no significant differences in general information,laboratory indicators and TCM syndrome scores between the two groups（P>0.05）.2.After 6 months of treatment,24-hour urinary protein quantity,serum albumin,serum anti-phospholipase A2 receptor antibody,low density lipoprotein,triglyceride,total cholesterol,blood creatinine,cystatin C,serum retinol-binding protein and urinaryβ₂microglobulin in 2 groups were effectively improved（P<0.05）;After treatment,urea nitrogen level of experimental group was decreased compared with before（P<0.05）,but there was no significant difference in urea nitrogen level of control group compared with before treatment（P>0.05）.The experimental group had better efficacy than the control group in reducing 24-hour urinary protein quantity,serum anti-phospholipase A2 receptor antibody,low density lipoprotein,urea nitrogen,cystatin C,serum retinol-binding protein and urinaryβ₂ microglobulin,and increasing serum albumin（P<0.05）.However,in reducing total cholesterol,triglyceride and serum creatinine,There was no significant difference between the two groups（P>0.05）.3.Correlation analysis showed that serum retinol-binding protein had positive rank correlation with serum creatinine,urea nitrogen,total cholesterol and low density lipoprotein（LDL）（P<0.05）.4.In terms of the clinical efficacy of Western medicine,the total effective rate of the experimental group was 72.73%,and that of the control group was 64.70%,the difference was not statistically significant（P>0.05）.Compared with before treatment,TCM syndrome scores in both groups were significantly decreased（P<0.01）,and TCM syndrome scores in experimental group were significantly decreased compared with control group（P<0.01）.The effective rate of TCM syndrome in experimental group（84.85%）>control group（61.76%）,there was statistical difference（P<0.05）.5.In terms of safety,there were no significant changes in stool routine,electrocardiogram,liver function,fasting blood glucose and other safety indexes in the two groups during treatment;The incidence of adverse reactions in control group and experimental group was 8.82%and 5.88%,respectively,with no statistical difference（P>0.05）.Conclusions:Simiao Sijun Decoction combined with Tripterygium wilfordii polyglycoside tablets can improve clinical symptoms of IMN patients with damp heat accumulation and spleen deficiency type,reduce urinary protein,reduce serum anti-phospholipase A2 receptor antibody level,improve serum albumin,improve renal function and lipid metabolism disorders,and it is safe and worthy of clinical application and promotion.Moreover,serum retinol-binding protein level is correlated with renal function and lipid metabolism indexes,and monitoring the serum retinol-binding protein level can provide a reference for the evaluation of IMN.