Characteristics Of TCM Syndromes Of Nephrotic Syndrome With Pulmonary Infection By The Immunosuppressive Treatment

ObjectiveThrough making a retrospective study of the data of hospitalized cases with nephrotic syndrome(NS) with complication of pulmonary infection by the immunosuppressive treatment, to analyze its clinical features.pathological features, clinical characteristics of TCM, summarize clinical experience which is in order to improve the treatment and prevention level of inpatients with nephrotic syndrome complicated by lung infection prevention by the immunosuppressive treatment.MethodsMaking a retrospective study of the data of hospitalized NS cases with copmpliction of lung infection which were received by Guangdong Provincial Hospital of TCM from 2010 to 2015; analyzing their admission informations, hospital materials, pathological features, clinical manifestations of pneumonia, laboratory testing and examination, etiology characteristics, initial antibiotic treatment, and clinical symptoms, the tongue, pulse condition and symptom of TCM, prognosis of diseases, finally the traditional Chinese medicine treatments, the analysis of death case, and summary of clinical experience will be concluded. The cases were divided into groups by severity of lung infections, severe and non-severe group, gathering Laboratory test when they received renal biopsy and suffered from lung infections respectively, analyzing differences between two groups.Results1.41 cases were collected in this study,14 cases of Severe group and 27 cases of non-Severe group.6 cases (14.83%) died, the dead over than or equal to 50 years old.41 patients with pulmonary infection occurred 9 days to 35 months after immunosuppressive therapy,27 cases (65.85%) within 3 months, 7 cases (17.07%) in 3-6months, and 7 cases (17.07%) beyond 6 months. Immunosuppressive regimen most used was GC+CTX(18 cases,43.90%), followed by GC alone (13 cases,31.70%), GC+FK506(4 cases,9.76%), GC+MMF(4 cases,9.76%), GC+CsA(1 cases,2.44%), GC+CTX+LEF(1 cases,2.44%).2. Main Pathological type wwas membranous nephropathy (20 cases,48.78%), followed by MCD(8cases,19.51%), FSGS(5cases,12.20%), LN(3cases,7.32%), IgA(3cases,7.32%), Mesangial proliferative glomerulonephritis(2 cases,4.88%), Proliferative and sclering glomerulonephritides (1 cases,2.44%),26(63.41%) of 41 of renal biopsy pathology showed renal interstitial f ibrosis.3. The lab data showed white blood cells, hemoglobin, platelets, lymphocytes, neutrophils, lipid and quantitative test of 24h urinary protein had no significant difference between severe group and non-severe group when they received renal biopsy(P>0.05);The data collected at admission of infection found that neutrophils was higher in severe group than non-severe group (P<0.05). While white blood cells, hemoglobin, platelets, blood urea nitrogen, creatinine, triglycerides, cholesterol,serum albumin, procalcitonin, blood glucose had no significant difference.4.16 of 41 cases found pathogens, the positive rate was 39.02%.31 cases successfullydid sputum culture test,13 cases detected pathogens, sputum culture positive rate was 31.71%.39 times with 14 different times pathogens, mainly bacteria pathogens(25 times,64.10%), followed by fungi (14 times, 35.90%), virus (2 times,5.13%).5. According to the frequency of tongue-fur’s and pulse condition it could be ranked as follows:dark-pale(63.41%), dark-red(21.95%), red(12.20%), light(2.44%);white greasy(white, thick and greasy)(39.02%), yellow greasy (thick greasy yellow)(31.71%), white (thin, white)(12.20%), yellow (light yellow)(7.32%); thin pulse(58.84%), slippery pulse(31.71%),deep pulse(31.71%), rapid pulse(29.27%),string pulse(24.39%);The main character of pulmonary infections was excess(58.54%) and deficiency-excess mixing(34.15%), Qi(31.71%) and Yin(9.76%) deficiency was common in deficiency, while heat(53.66%), dump(41.46%), blood stasis(36.59%), phlegm(34.15%), wind(26.83%) and cold(14.63%)were common in excess. According to the frequency of TCM syndrome type it could be ranked as follows:phlegm-heat obstructing in the lung(19.51%), wind-heat affecting lung(9.76%), Qi and yin deficiency, damp-heat stasis(9.76%), spleen and kidney qi deficiency, water-wet stasis(9.76%), wind evil invading the lung(7.32%), phlegm-dampness accumulated in the lung (7.32%). Characteristic of using herbs:There were five chasses of herbs:expectorants, antitussives and herbs for relieving dyspnea, tonic herbs, heat-clearing herbs, herbs for treating exterior syndromes and inhibiting-damp herbs had the highest frequency.ConclusionNephrotic syndrome with pulmonary infection by the immunosuppressive treatment often occur within 3 months after immunosuppressive therapy, it was of severe illness, had low pathogen detection positive rate and high mortality in the elderly; GC and cyclophosphamide was the main immunosuppressive regimen, main pathologic type was membranous nephropathy, half of the patients with renal interstitial fibrosis, Therefore, these patients should be strengthened in clinical follow-up and the prevention of infection. In TCM aspect Nephrotic syndrome with pulmonary infection by the Immunosuppressive Treatment, The character of pulmonary infection was deficiency-excess mixing, so its treatment focused on supporting healthy qi and removing pathogenic factors.