Study On The Efficacy Of Warming Yang And Relieving Exterior Syndrome In The Treatment Of Primary Membranous Nephropathy And Its Regulatory Effect On Serum BAF

ObjectiveThis study aims to elucidate the changes of serum BAFF before and after the treatment of Mahuang Fuzi Decoction and Shenzhu Decoction,and to evaluate the effect of BAFF at idiopathic membranous nephropathy.MethodsSixty-eight patients with PMN were enrolled in this study,all of whom were diagnosed by kidney biopsy or serum anti-phospholipase A2 receptor antibody positive,and all of whom were treated with the treatment plan of Wenyang Jiebiao method with Mahuang Fuzi Decoction and Shenzhu Decoction as the main formula.Clinical and laboratory indicators of patients before treatment were taken as baseline data,and repeated laboratory indicators were detected every 3 months as nodes.The main outcome of this study is the compound outcome that meets the standard of complete or partial remission.Complete remission standard is defined as simultaneously satisfying:24h urine protein<0.3g,normal renal function,normal serum albumin,and disappearance of clinical symptoms.Some remission criteria are defined as simultaneously satisfying:24-hour urine protein quantity<3.5g and decreased by more than 50%compared with the basic value,and blood albumin was higher than before treatment,but it was not normal,and the renal function was normal.ResultsThe changes of laboratory indexes of 68 patients before and after treatment were analyzed,and it was found that after treatment,ALB,serum BAFF,24hUTP,TG,CHO and SCr were significantly decreased.According to the results of statistical analysis and clinical experience,the relevant factors affecting the remission of patients were screened out.The results showed that ALB,24hUTP and TG before treatment were independent influencing factors for the remission time of PMN treated by this regimen,that is,the lower ALB and the higher 24hUTP,the longer the time for patients to achieve clinical remission.Serum BAFF level was positively correlated with IL-35 level(correlation coefficient was 0.63),and the difference was statistically significant(P<0.05).There was no correlation with sex,24hUTP,ALB,anti-PLA2R antibody positive,anti-PLA2r antibody titer,diabetes mellitus,hypertension,immunosuppressant or not.ROC curve analysis was performed for anti-Pla2R-positive PMN patients with BAFF and anti-Pla2R antibody titers to achieve clinical response outcome(composite outcome of partial response and complete response).The area under curve of anti-PLA2R antibody was 0.546 and that of serum BAFF was 0.637.The diagnostic efficacy of BAFF was higher than that of anti-PLA2R antibody titer.ConclusionThe treatment of idiopathic membranous nephropathy with Mahuang Fuzi Decoction and Shenzhu Decoction as the main formula has significant effect,low recurrence rate and high safety.The serum BAFF level of PMN patients can be increased by"Wen-Yang-Jie-Biao"treatment.Serum BAFF was positively correlated with IL-35.