参芪降浊汤治疗特发性膜性肾病脾肾气虚兼血瘀证临床研究OA

Objective To observe the clinical efficacy of Shenqi Jiangzhuo Decoction in patients with idiopathic membranous nephropathy(IMN)with spleen-kidney qi deficiency and blood stasis syndrome,as well as its effects on hypercoagulable state,inflammatory factors and renal interstitial fibrosis.Methods Totally 72 patients were divided into the control group and the treatment group according to hierarchical randomization method,with 36 cases in each group.Both groups were given basic treatment such as immunosuppression,anticoagulation and blood pressure and lipid regulation.The treatment group was given oral Shenqi Jiangzhuo Decoction,while the control group received Chinese materia medica placebo orally.The treatment course for both groups was 8 weeks.The clinical efficacy of both groups was observed.The TCM syndrome scores,the indicators of renal function[24-hour urine protein quantification(24 hUp),glomerular filtration rate(eGFR),serum creatinine(SCr),blood urea nitrogen(BUN)],coagulation indicators[fibrinogen(FIB),D-dimer(D-D),von Willebrand factor(vWF)],inflammatory factor indicators[interleukin(IL)-6,IL-17,B lymphocyte activation factor(BAFF),helper T cell 17(Th17)/regulatory T cell(Treg)ratio],and interstitial fibrosis indicators[connective tissue growth factor(CTGF),laminin(FN)]of both groups before and after treatment were evaluated.The blood and urine routine,liver function,ECG and other indicators of the two groups were monitored,and the adverse events were recorded.Results The total effective rate of the treatment group was 88.89%(32/36),and that of the control group was 77.78%(28/36).The clinical efficacy of the treatment group was better than that of the control group(P<0.05).Compared with before treatment,the scores of lower extremity edema,scanty urine and clear urine,soreness and stabbing pain in the waist and sacrum,loose stools,numbness in limbs,and skin and nail changes in the control group decreased significantly after treatment(P<0.05),the symptom scores of the treatment group decreased significantly(P<0.05);after treatment,the scores of lower extremity edema,scanty urine and clear urine,poor appetite and laziness in speech,abdominal distension,loose stools,skin and nail changes in the treatment group were significantly lower than the control group(P<0.05).Compared with before treatment,the 24 hUp,SCr,BUN,FIB,D-D,vWF,IL-6,BAFF,CTGF,FN and the ratio of Th17/Treg in both groups decreased significantly after treatment(P<0.05),and the eGFR level increased significantly(P<0.05);after treatment,the 24 hUp,SCr,FIB,vWF,IL-6,BAFF,FN levels and the ratio of Th17/Treg in the treatment group were significantly lower than the control group(P<0.05),and the eGFR level was significantly higher than the control group(P<0.05).The incidence of adverse reactions in the control group and the observation group was 5.6%(2/36)and 2.8%(1/36)respectively,without statistical significance(P>0.05).Conclusion Shenqi Jiangzhuo Decoction has a significant effect on improving the levels of renal function,coagulation,inflammatory factors and interstitial fibrosis in IMN patients with spleen-kidney qi deficiency and blood stasis syndrome,which can delay the progression of IMN.