Abstract:

Objective　To explore the efficacy of Jiawei Buyang Huanwu Tang combined with western medicine in the treatment of patients with idiopathic membranous nephropathy. Methods　A total of 120 patients with idiopathic membranous nephropathy treated at Yulin Traditional Chinese Medicine Hospital from September 2020 to September 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 60 cases in each group. There were 42 males and 18 females in the control group; they were (49.68±5.62) years old. There were 44 males and 16 females in the observation group; they were (49.81±5.54) years old. The control group took tacrolimus, while the observation group took Jiawei Buyang Huanwu Tang and tacrolimus, for 6 months. The clinical efficacies, lipid metabolism levels [total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL)], renal function [24-hour urinary total protein (24 h-UTP), serum creatinine (Scr), and blood urea nitrogen (BUN)], inflammatory markers [transforming growth factor-β1 (TGF-β1), podocyte protein (PCX), and cystatin C (CysC)], and coagulation-fibrinolysis function [tissue plasminogen activator (t-PA) and type Ⅰ plasminogen activator inhibitor [PAI-Ⅰ]) before and after the treatment, and adverse reactions were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The overall efficacy in the observation group was higher than that in the control group [95.00% (57/60) vs. 80.00% (48/60)], with a statistical difference (χ²=6.171; P<0.05). After the treatment, the levels of TC, TG, LDL, 24 h-UTP, Scr, BUN, TGF-β1, PCX, CysC, t-PA, and PAI-Ⅰ in the observation group were better than those in the control group [(4.31±0.96) mmol/L vs. (6.39±1.24) mmol/L, (1.61±0.46) mmol/L vs. (2.49±0.72) mmol/L, (1.23±0.24) mmol/L vs. (2.59±0.41) mmol/L, (0.56±0.24) g vs. (1.34±0.37) g, (82.57±7.16) μmol/L vs. (88.49±8.64) μmol/L, (6.02±1.03) mmol/L vs. (7.34±1.28) mmol/L, (235.25±14.76) ng/L vs. (301.59±17.64) ng/L, (7.11±1.42) μg/L vs. (12.24±1.78) μg/L, (0.82±0.22) mg/L vs. (1.18±0.34) mg/L, (6.88±1.07) μg/L vs. (5.42±0.97) μg/L, and (22.01±2.08) μg/L vs. (26.78±2.63) μg/L; t=10.274, 7.978, 22.174, 13.700, 4.087, 6.223, 22.341, 17.451, and 6.886, 7.831, and 11.019; all P<0.05]. There was no statistical difference in the incidence rate of adverse reactions between the two groups (P>0.05). Conclusion　Jiawei Buyang Huanwu Tang and tacrolimus in the treatment of patients with idiopathic membranous nephropathy is effective, and can improve their lipid metabolism, renal function, inflammatory status, and coagulation-fibrinolysis function.

Key words:

Idiopathic membranous nephropathy, Jiawei Buyang Huanwu Tang, Tacrolimus, Renal function, Inflammatory markers

摘要：

目的　探讨加味补阳还五汤联合西药治疗特发性膜性肾病患者的效果。方法　选取2020年9月至2023年9月榆林市中医医院收治的120例特发性膜性肾病患者进行随机对照试验。采用随机数字表法将其分为对照组和观察组，各60例。对照组男42例，女18例，年龄（49.68±5.62）岁。观察组男44例，女16例，年龄（49.81±5.54）岁。对照组予以他克莫司治疗，观察组予以加味补阳还五汤联合他克莫司治疗。两组均治疗6个月。比较两组临床疗效，治疗前后脂代谢水平［总胆固醇（total cholesterol，TC）、三酰甘油（triglycerides，TG）、低密度脂蛋白（low-density lipoprotein，LDL）］、肾功能［24 h尿蛋白定量（24-hour urinary total protein，24 h-UTP）、血肌酐（serum creatinine，Scr）、尿素氮（blood urea nitrogen，BUN）］、炎症因子［转化生长因子-β1（transforming growth factor-β1，TGF-β1）、人足细胞标志蛋白（podocyte protein，PCX）、胱抑素C（cystatin C，CysC）］、凝血纤溶功能［组织型纤溶酶原激活物（tissue plasminogen activator，t-PA）、Ⅰ型纤溶酶原激活物抑制因子（type Ⅰ plasminogen activator inhibitor，PAI-Ⅰ）］，不良反应发生情况。采用χ²检验、t检验进行统计分析。结果　观察组治疗总有效率高于对照组［95.00%（57/60）比80.00%（48/60）］，差异有统计学意义（χ²=6.171，P<0.05）。治疗后，观察组TC、TG、LDL水平均低于对照组［（4.31±0.96）mmol/L比（6.39±1.24）mmol/L、（1.61±0.46）mmol/L比（2.49±0.72）mmol/L、（1.23±0.24）mmol/L比（2.59±0.41）mmol/L］，差异均有统计学意义（t=10.274、7.978、22.174，均P<0.05）。治疗后，观察组24 h-UTP、Scr、BUN水平均低于对照组［（0.56±0.24）g比（1.34±0.37）g、（82.57±7.16）μmol/L比（88.49±8.64）μmol/L、（6.02±1.03）mmol/L比（7.34±1.28）mmol/L］，差异均有统计学意义（t=13.700、4.087、6.223，均P<0.05）。治疗后，观察组TGF-β1、PCX、CysC水平均低于对照组［（235.25±14.76）ng/L比（301.59±17.64）ng/L、（7.11±1.42）μg/L比（12.24±1.78）μg/L、（0.82±0.22）mg/L比（1.18±0.34）mg/L］，差异均有统计学意义（t=22.341、17.451、6.886，P<0.05）。治疗后，观察组t-PA水平高于对照组［（6.88±1.07）μg/L比（5.42±0.97）μg/L］，PAI-Ⅰ水平低于对照组［（22.01±2.08）μg/L比（26.78±2.63）μg/L］，差异均有统计学意义（t=7.831、11.019，P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论　加味补阳还五汤联合他克莫司治疗特发性膜性肾病患者效果较好，能有效改善患者脂代谢水平、肾功能、炎症状态及凝血纤溶功能。

关键词:

特发性膜性肾病, 加味补阳还五汤, 他克莫司, 肾功能, 炎症因子