加味补阳还五汤联合他克莫司治疗气虚血瘀型特发性膜性肾病的效果及对凝血纤溶功能、PLA2R、THSD7A水平的影响

Effect of modified Buyang Huanwu decoction combined with tacrolimus in the treatment of idiopathic membranous nephropathy of Qi deficiency and blood stasis type and its influences on coagulation-fibrinolysis function,PLA2R and THSD7A levels

目的 探讨加味补阳还五汤联合他克莫司治疗气虚血瘀型特发性膜性肾病(IMN)的效果。方法 选择2019年2月至2021年3月我院收治的86例气虚血瘀型IMN患者作为研究对象,根据随机数字表法将其分为对照组与观察组,各43例。对照组给予他克莫司治疗,观察组在对照组基础上给予加味补阳还五汤治疗。比较两组的临床疗效、肾功能指标[血肌酐(Scr)、24 h尿蛋白定量、肾小球滤过率(eGFR)]、凝血纤溶指标[组织型纤溶酶原激活物(t-PA)、Ⅰ型纤溶酶原激活物抑制因子(PAI-Ⅰ)]、M型磷脂酶A2受体(PLA2R)和1型血小板反应蛋白7A域(THSD7A)水平。结果 观察组的治疗总有效率为95.35%,高于对照组的79.07%,差异具有统计学意义(P<0.05)。治疗后,观察组的Scr水平、24 h尿蛋白定量低于对照组,eGFR高于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的t-PA水平高于对照组,PAI-Ⅰ水平低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的PLA2R、THSD7A水平低于对照组,差异具有统计学意义(P<0.05)。结论 加味补阳还五汤联合他克莫司治疗气虚血瘀型IMN的效果满意,可改善凝血纤溶功能,抑制PLA2R、THSD7A表达。

Objective To explore the effect of modified Buyang Huanwu decoction combined with tacrolimus in the treatment of idiopathic membranous nephropathy(IMN) of Qi deficiency and blood stasis type.Methods A total of 86patients with IMN of Qi deficiency and blood stasis type admitted in our hospital from February 2019 to March 2021 were selected as the research objects.The patients were divided into control group and observation group according to random number table method,with 43 cases in each group.The control group was treated with tacrolimus,and the observation group was treated with modified Buyang Huanwu decoction on the basis of the control group.The clinical efficacy,renal function indexes [serum creatinine(Scr),24-h urine protein quantification,estimated glomerular filtration rate(eGFR)],coagulation-fibrinolysis indexes [tissue-plasminogen activator(t-PA),plasminogen activator inhibitor-type Ⅰ(PAI-Ⅰ)],M-type phospholipase A2 receptor(PLA2R) and thrombospondin type-1 domain-containing 7A(THSD7A) levels were compared between the two groups.Results The total effective rate of treatment in the observation group was 95.35%,which was higher than 79.07% in the control group,and the difference was statistically significant(P<0.05).After treatment,the Scr level and 24-h urine protein quantification of the observation group were lower than those of the control group,the e GFR was higher than that of the control group,and the differences were statistically significant(P<0.05).After treatment,the level of t-PA in the observation group was higher than that in the control group,the level of PAI-Ⅰwas lower than that in the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of PLA2R and THSD7A in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion modified Buyang Huanwu decoction combined with tacrolimus in the treatment of IMN of Qi deficiency and blood stasis type has a satisfactory effect,which can improve the coagulation-fibrinolysis function and inhibit the expression of PLA2R and THSD7A.