Synergistic And Attenuated Effects Of Nourishing Yin And Clearing Heat On Primary Membranous Nephropathy Clinical Observation

BACKGROUND:The main lesion of membranous nephropathy is located in glomerular basement membrane,which is a glomerular disease characterized by diffuse deposition of immune complex under visceral epithelial cells,thickening of glomerular basement membrane and formation of "nail process".Membranous nephropathy can be divided into primary,secondary and familial according to the pathogenesis.Primary membranous nephropathy is the most common histopathological type that causes adult nephrotic syndrome and is one of the major glomerular diseases that cause adult end-stage kidney disease.Treatment of primary membranous nephropathy includes general treatment and immunosuppressive treatment.Long-term observation shows that patients with primary membranous nephropathy often have regular syndrome changes during immunosuppressive therapy,i.e.syndrome changes of water-dampness internal stagnation-yin deficiency,fire hyperactivity,qi-yin deficiency or yin-yang deficiency.In the treatment stage of sufficient glucocorticoid,patients often suffer from yin deficiency and fire hyperactivity syndrome,such as insomnia,dreaminess,five vexations,fever,excitement,convulsion,dry mouth and throat,red tongue,little coating,thready pulse,etc.[2].TCM should give yin nourishing and fire reducing methods to symptomatic treatment to antagonize its side effects.OBJECTIVE:To explore the synergistic and toxic effects of nourishing yin and clearing heat in immunosuppressive therapy of primary membranous nephropathy.METHODS:80 patients who met the inclusion criteria were randomly divided into treatment group(40 patients)and control group(40patients),of which 27 were male and 13 were female.There were 24 males and 16 females in the control group.There was no significant difference between the two groups in general clinical data such as gender,age and course of disease(P > 0.05),which was comparable.Both groups were given general treatment and immunosuppressive treatment.The treatment group was additionally treated with traditional Chinese medicine for nourishing yin and clearing heat on this basis.Specifically,for about 1-2 weeks of immunosuppressive treatment,the patients showed the clinical manifestations of yin deficiency and fire hyperactivity syndrome.According to the theory of meridian tropism of disease drugs,the treatment group was treated with yin nourishing and clearing heat prescription.Laboratory indexes were observed after 3 weeks,6weeks of treatment,and Chinese medicine symptoms of yin deficiency and fire hyperactivity after 6 weeks of treatment.Statistical analysis was carried out within and between the two groups before and after treatment.The main laboratory indexes include 24-hour urine protein,ratio of urine protein to creatinine,serum albumin,serum creatinine and glomerular filtration rate.SPSS 22.0 software was used to analyze and compare the experimental data in this study.RESULTS:During this study,one patient with treatment intolerance appeared in the control group and was excluded.The laboratory indexes of 24-hour urinary protein,ratio of urinary protein to creatinine and serum albumin were compared between the two groups,and the difference was statistically significant(P < 0.05).The difference in therapeutic effect between the two groups was statistically significant.After treatment,the scores of TCM syndromes(five vexations and fever,hectic fever and night sweat,insomnia and dreaminess,dry throat and mouth,dizziness and tinnitus,soreness of waist and knees,red zygomatic,tongue coating and pulse condition)of the two groups were statistically analyzed and compared,and the difference was statistically significant(p < 0.05).After treatment,the effective rates of traditional Chinese medicine in the treatment group and the control group were 95% and76.9%,respectively,with statistically significant difference(P< 0.05).The effective rates of western medicine were 90% and 82%respectively,the difference was statistically significant(p <0.05).Conclusion:Nourishing yin and clearing heat can improve the toxic and side effects of patients with primary membranous nephropathy during immunosuppressive therapy,improve laboratory indicators and enhance clinical efficacy.