| Objective:To explore the correlation between the sensitivity of idiopathic membranous nephropathy to immunosuppressants and TCM Syndrome Types,and to provide theoretical basis for the diagnosis and treatment of idiopathic membranous nephropathy.Methods:Methods: from January 2012 to December 2020,114 patients with idiopathic membranous nephropathy(IMN)who were diagnosed by renal biopsy in Ruikang Hospital Affiliated to Guangxi University of traditional Chinese medicine and received cyclophosphamide(CTX),cyclosporine A(Cs A)or tacrolimus(FK506)treatment and met the inclusion criteria were retrospectively analyzed.A unified case observation table was established,in which the first visit of patients was truthfully recorded The four diagnostic data of traditional Chinese medicine,the pathological stage of the patients,the type of immunosuppressive therapy and the laboratory indexes of renal function,serum albumin,blood lipid,24-hour urinary protein before treatment,3 months and 6 months after treatment were analyzed.According to the four diagnostic data of traditional Chinese medicine,the TCM syndrome types of patients were determined,and the efficacy of immunosuppressive therapy was determined according to the laboratory indexes of patients at different stages of treatment.To compare the remission rate of patients with different TCM syndromes in the same immunosuppressive therapy,and to compare the remission rate of patients with different immunosuppressive therapy in the same TCM syndrome.Results:1.In terms of gender,age and course of disease,there were 65 males and 49 females,with a male to female ratio of 1.33:1.The oldest was 78 years old,and the youngest was 14 years old,with an average age of50.95±12.24 years.The longest course was 4 years and the shortest was 5days.The average course was 6.25±8.94 months.There was no significant difference in gender,age and course of disease among patients with different TCM syndrome types.2.In terms of pathological staging,there were 25 patients in stage I,accounting for 23.8%,71 patients in stage II,accounting for 62.28%,and 18 patients in stage III,accounting for 15.79%.There was no significant correlation between pathological stage and TCM syndrome type(P>0.05).There was no significant difference in remission rate among patients with different pathological stages in CTX,Cs A and FK506 regimens(P>0.05).In stage II patients,the remission rate of different immunosuppressive regimens for 3 months was statistically different(P=0.004<0.05).By pairwise comparison,the remission rate of Cs A regimen was significantly higher than that of CTX regimen(P=0.025<0.05),and that of FK506 regimen was significantly higher than that of CTX regimen(P=0.006<0.05);After 6months of treatment,there was no significant difference in remission rate among the three regimens(P>0.05).In stage I and III patients,the remission rates of different immunosuppressive regimens for 3 months and 6 months were not statistically different(P>0.05).3.In terms of laboratory examination indexes,there were no significant differences in serum creatinine,urea nitrogen,serum uric acid,24-hour urinary protein,serum albumin,triglyceride and total cholesterol among patients with different TCM syndrome types before immunosuppressive treatment(P>0.05).4.In the same immunosuppressive treatment scheme,the remission rate of different TCM Syndrome Types in CTX scheme after 3 months of treatment was as follows: spleen and kidney yang deficiency syndrome(33.33%)> Yin deficiency damp heat syndrome(29.41%)> Qi and yin deficiency syndrome(22.22%)> blood stasis syndrome(14.28%),χ~2=1.803,P=0.614>0.05,the difference was not statistically significant.After 6 months of treatment,the remission rates of different syndrome types were: spleen and kidney yang deficiency syndrome(83.3%)> Qi and yin deficiency syndrome(55.56%)> Yin deficiency and damp heat syndrome(52.94%)> blood stasis syndrome(28.57%),χ~2=11.396,P=0.009<0.05,the difference was statistically significant.After pairwise comparison,it was found that the remission rate of patients with spleen and kidney yang deficiency syndrome was significantly higher than that of patients with blood stasis syndrome(P=0.001<0.0083).In Cs A regimen,the remission rates of different syndrome types after 3 months of treatment were as follows: Yin deficiency and damp heat syndrome(76.92%)> Qi and yin deficiency syndrome(50%)> spleen and kidney yang deficiency syndrome(40%)> blood stasis syndrome(16.67%),P=0.088>0.05,with no significant difference.After 6 months of treatment,the remission rates of different syndrome types were as follows:Yin deficiency and damp heat syndrome(92.31%)> spleen and kidney yang deficiency syndrome(80%)> Qi and yin deficiency syndrome(50%)> blood stasis syndrome(33.3%),P=0.025<0.05,the difference was statistically significant.The remission rate of yin deficiency and damp heat syndrome was significantly higher than that of blood stasis syndrome(P=0.017<0.05).In FK506 scheme,the remission rates of different syndrome types after 3months of treatment were:spleen and kidney yang deficiency syndrome(87.5%)> Yin deficiency and damp heat syndrome(71.43%)> Qi and yin deficiency syndrome(66.67%)> blood stasis syndrome(25%),P=0.18>0.05.After 6 months of treatment,the remission rates of different syndrome types were:spleen and kidney yang deficiency syndrome(87.5%)>Yin deficiency and damp heat syndrome(85.71%)> Qi and yin deficiency syndrome(66.67%)> blood stasis syndrome(50%),P= 0.442>0.05.5.Comparison of remission rate of different immunosuppressants in the same TCM syndrome type.Patients with spleen kidney yang deficiency syndrome were treated for 3 months,the remission rates of CTX,Cs A and FK506 were 33.3%,40% and 87.5%,P=0.032<0.05,and the difference was statistically significant.Pairwise comparison found that the remission rate of FK506 was significantly higher than that of CTX(P=0.013<0.05).The treatment lasted for 6 months,the remission rates of CTX,Cs A and FK506 were 83.3%,80% and 87.5%,P=1.0>0.05,and the difference was not statistically significant.Patients with Yin deficiency and damp heat syndrome were treated for 3 months,the remission rates of CTX,Cs A and FK506 were29.41%,76.92% and 71.43%,P=0.03<0.05,and the difference was statistically significant.Pairwise comparison found that the remission rate of Cs A was significantly higher than that of CTX(P=0.025<0.05).After 6months of treatment,the remission rates of CTX,Cs A and FK506 were52.94%,92.31% and 85.71%,P=0.043<0.05,and the difference was statistically significant.Pairwise comparison found that the remission rate of Cs A was significantly higher than that of CTX(P=0.042<0.05).The remission rates of CTX,Cs A and FK506 in patients with blood stasis syndrome and Qi Yin deficiency syndrome after 3 and 6 months of treatment were not statistically different(P>0.05).Conclusion(s):1.CTX,Cs A and FK506 had obvious curative effect on IMN of spleen kidney yang deficiency syndrome after 6 months of treatment,but CTX and Cs A had no obvious curative effect after 3 months of treatment,FK506 had obvious curative effect.2.Cs A and FK506 were more effective than CTX in the treatment of IMN patients with Yin deficiency and damp heat syndrome for 3 and 6months.Therefore,IMN patients with Yin deficiency and damp heat syndrome is more sensitive to Cs A and FK506 than CTX.3.The sensitivity of IMN patients with blood stasis syndrome to CTX,Cs A and FK506 was poor,and the curative effect was not obvious after 3 and6 months of treatment. |
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