| ObjectiveThrough retrospective analysis of the clinical efficacy and risk factors of the treatment of idiopathic membranous nephropathy with "Invigorating the spleen and invigorating qi,promoting blood circulation and detoxifying" program of traditional Chinese medicine,To clarify the effectiveness and safety of each treatment plan.MethodUsing a single-center retrospective study method,the clinical data of IMN patients in nephrology ward and outpatient clinic of Longhua Hospital from January 2014 to January 2019 were collected and sorted out strictly according to the standard of exclusion.The incidence,TCM syndromes,medication and efficacy evaluation of idiopathic membranous nephropathy were analyzed.The medication characteristics and efficacy differences of different treatment schemes were summarized,and the effects were analyzed.Risk factors,etc.According to different data types,the relevant statistical analysis was carried out,and the relevant conclusions were obtained based on the statistical tests and the clinical significance.Result1.General information:244 Cases of IMN were included in the study.The ratio of male to female was 1.49:1.Most of them were middle-aged and old,accounting for 77.87% of the age over 40 years old.The duration of disease was less than 6 months,accounting for 77.87%.Syndrome differentiation of TCM belongs to deficiency of spleen and kidney Qi.The syndrome of blood stasis(28.69%)and heat toxin(26.23%)are the main symptoms of syndrome differentiation.2.Treatment sitution:98 cases were enrolled in the simple Chinese medicine treatment group(without hormone and/or immunosuppressive treatment);80 cases in the integrated Chinese and Western medicine treatment group(combined with hormone and/or immunosuppressive treatment);66 cases in the ineffective western medicine treatment group(hormone and/or immunosuppressive treatment after ineffective use of traditional Chinese medicine treatment).3.Treatment outcome:The remission rate was 81.63% in Chinese medicine group,71.25% in combination group and 66.67% in ineffective group.The total remission rate and recurrence rate of 244 IMN patients were 74.18% and 2.87%respectively.During the follow-up period,12 patients entered the endpoint.In the traditional Chinese medicine group,the 24-hour urinary protein quantificationin before and after treatment was 3.15±1.53 and 1.37±1.77 respectively,and serum albumin was 31.03±8.47 and 37.44±8.16 respectively,with significant difference(p<0.05).In the integrated Chinese and Western medicine group,the 24-hour urinary protein quantification before and after treatment was 3.61±1.67 and 1.61±1.96,serum albumin was 28.83±8.55 and 35.9±8.94 respectively,with statistical significance(p<0.05).In the ineffective western medicine group,the 24-hour urinary protein was 5.03±2.09 and 2.52±1.88,serum albumin was 26.14±7.9 and 31.07±9.52 before and after treatment,with statistical significance(p<0.05).After treatment,cholesterol and low density lipoprotein in the three groups were lower than before,with statistical significance(p<0.05).The other indicators were stable before and after treatment,with no statistical significance(p>0.05).4.Relevant factors affecting the curative effect:gender,hypertension,course of treatment,albuminuria and serum albumin were the influencing factors of prognosis in each treatment group,combined medication was the influencing factor of prognosis in simple Chinese medicine group,and Scrlevel was the influencing factor of prognosis in western medicine ineffective group.Multivariate logistic regression analysis suggested that hypertension,serum albumin and proteinuria might be independent factors affecting the efficacy of the regimen in the treatment of IMN.Conclusion1.IMN is commonly seen in middle-aged and elderly men.The first symptoms are edema and foam urine,and most of them are nephrotic syndrome.The pathological stages were mainly stage?and stage?.2.IMN dialectical syndrome is mostly a virtual standard,spleen and kidney qi deficiency is its basic pathogenesis,and the standard evidence is blood stasis and heatt oxicity.3.The traditional Chinese medicine "invigorating the spleen,invigorating qi,activaing blood and detoxifying" has a definite curative effect on IMN,with a low recurrence rate,and the longer the treatment time,the better the curative effect and the higher the remission rate.The long-term effect of traditional Chinese medicine alone is the best,and the combination of Chinese and Western medicine has the fastest effect.The efficacy of traditional Chinese medicine in the treatment of invalid western medicine is considerable.4.Traditional Chinese medicine has a positive effect on reducing urinary protein,improving serum albumin and protecting renal function,and has a certain effect of anticoagulation.5.Proteinuria,hypertension and serum albumin are related factors affecting the treatment of IMN by "invigorating the spleen and invigorating qi,promoting blood circulation and detoxifying" regimen. |
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