Observation on curative effect of traditional Chinese medicine combined with cyclophosphamide pulse therapy on refractory nephrotic syndrome in children

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Yuan Bin 1 Liu Guangling 2 sun Yiqiu summer 1 Zhengkun 2 high 2 Zhongmin 2 fu fan is in 2 Huijie 11 Affiliated Hospital of Nanjing Universit

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Yuan Bin 1 Liu Guangling 2 sun Yiqiu summer 1 Zhengkun 2 high 2 Zhongmin 2 fu fan is in 2 Huijie 1

1 Affiliated Hospital of Nanjing University of Chinese Medicine;; China; Nanjing General Hospital of Nanjing military command

Abstract: Objective: To evaluate the therapeutic effect of traditional Chinese medicine combined with cyclophosphamide in the treatment of refractory nephrotic syndrome in children. Materials and methods: a total of 115 patients received cyclophosphamide pulse therapy in children with nephrotic syndrome, including 44 patients taking traditional Chinese medicine decoction, observe related indexes of the two groups, with two sets of Ridit analysis. Results: two cases of urinary protein negative group difference was not statistically significant, but the combination of Chinese and western group can significantly reduce the incidence of adverse reactions, and the use of hormone in children after appearing in the liver and kidney yin deficiency also decreased significantly. Conclusion: Traditional Chinese medicine combined with cyclophosphamide pulse therapy has important clinical significance in the treatment of refractory nephrotic syndrome in children.

Key words: Traditional Chinese medicine cyclophosphamide refractory nephropathy

Refractory nephrotic syndrome in children with nephrotic syndrome including steroid resistance, recurrence frequency and hormone dependence etc., studies have shown that children with nephrotic syndrome have more than half of the frequent occurrence of relapse, so high recurrence rate makes non steroid selection become necessary, usually in hormone therapy after failure to use other immunosuppressive therapy such as alkylating agent, such as cyclosporin. Of course, the remission rate of these immunosuppressive agents needs to be confirmed by more clinical trials.

How to increase the remission of nephrotic syndrome in children and avoid the adverse reactions of immunosuppressive agents as possible, has become the focus of attention. The role of traditional Chinese medicine in this area have been widely recognized, we recognize that in clinical TCM treatment of refractory nephropathy, can promote children nephropathy induced remission and reduce recurrence, and reduce the incidence of adverse reactions of immunosuppressant. This unit in the treatment of the disease, mainly using Chinese medicine dialectical therapy combined with cyclophosphamide, and achieved good results, with no obvious and permanent adverse reactions in children in remission period was prolonged, reduce the recurrence, the results are reported as follows:

Materials and methods

General information

The Affiliated Hospital of Nanjing University of Chinese Medicine and Chinese PLA Nanjing General Hospital of Nanjing military region paediatrics during 1996-2006 received cyclophosphamide pulse therapy in clinic and ward of the children with nephrotic syndrome, included 115 patients, aged 1-14 years, average 6.3 years old, and the ratio of 3: 1. Divided into two groups, the combination of Chinese and Western medicine group, a total of 44 cases; western medicine group, a total of 71 cases.

Two, treatment

The combination of Chinese and western group received cyclophosphamide and stick to the traditional Chinese medicine decoction, Chinese herbs: Radix Pseudostellariae 10g, 10g Poria, Polyporus 10g, white atractylodes rhizome 10g, Astragalus 10g, polygonatum 10g, orange peel 6G, Radix Paeoniae Alba 10g, Pteris grass 30g, Cornus 10g, valley malt 10g, herha 15g, Shenggan grass 3G; 1-3 at the age of 4-6 years old daily daily 1/2 agent, 2/3 agent, 6 years old one dose daily, two times a day; the western medicine group only received cyclophosphamide, two sets of other auxiliary treatment measures, such as hormones, support and anticoagulation. Cyclophosphamide dose of 8-15mg/kg/d, once a month, 8 times after the shock treatment every three months, a total of six months after the impact of the first half, the impact of the end of treatment 10.

Three, observation project

The main clinical observation of proteinuria disappeared time, 24 hours urinary protein quantitative changes and side effects such as gastrointestinal reactions, hemorrhagic cystitis, bone marrow suppression, liver function damage, due to the shorter observation time, the more long-term side effects is still a lack of systematic observation and study.

Four, statistical processing

The number of cases of urinary protein clearance within a certain period of time represented by the actual value, and mark the percentage. Two groups of average Ridit analysis were used to determine the western medicine group.

Results (see table below)

Table 1

Clearance time

The number of cases

group

Within 2 weeks

2-4 week

4-8 week

8 weeks later

Total

Western medicine group

13 (18.31%)

28 (39.44%)

23 (32.39%)

7 (9.86%)

Seventy-one

Integrated traditional Chinese and Western Medicine

8 (18.18%)

19 (43.18%)

13 (29.55%)

4 (9.09%)

Forty-four

Total

Twenty-one

Forty-seven

Thirty-six

Eleven

One hundred and fifteen

The western medicine group as the standard group, R Chinese and Western medicine group =0.49, the combination of TCM and Western medicine confidence interval (0.40, 0.58), including 0.5, there was no significant difference between the two groups.

Table two

Gastrointestinal reaction

Hemorrhagic cystitis

Myelosuppression

Liver function damage

Liver kidney yin deficiency syndrome

Western medicine group

23 (32.4%)

36 (50.7%)

3 (4.2%)

38 (53.5%)

Integrated traditional Chinese and Western Medicine

6 (13.6%)

1 (2.3%)

discuss

Children with nephrotic syndrome patients preferred hormone, but the recurrence rate is high, even in steroid sensitive nephrotic syndrome also have more than 80% cases of recurrence, the recurrence frequency is more about half, generally used in other immunosuppressive agents, including cyclophosphamide pulse therapy is a safe and effective therapy. But there are still some side effects such as gastrointestinal reaction and hemorrhagic cystitis. We use cyclophosphamide combined traditional Chinese medicine dialectical therapy, although the remission induction does not exist short-term advantages, its advantage lies in the long-term effect may control recurrence, and the observation that the treatment can effectively reduce the impact and side effects of hormone application, can effectively improve the clinical results.

Traditional Chinese medicine (TCM) has its unique advantages in the treatment of children with nephrotic syndrome, which can be used to solve different problems in different stages according to the different stages of the disease. We approach early in the course, namely the first attack at this time from edema disease, dialectical, if there is a virtual table card, and is not significant, can be treated from the evils of Fengshui; not only to the deficiency of fade, when the lack of differentiation of lung spleen and kidney, the edema is still in, not greasy early application fill the medicine, when the light penetration of lukewarm product allows the water outlet; and the refractory nephrotic syndrome recurrence is an important problem, so in remission after the drug is also extremely important, far-reaching impact on children, at this time we think mainly from the differentiation of lung and spleen to lung and Spleen Qi as the case for the cases of gas source, Wei Qi, Wei Lung spleen is solid, which can reduce the recurrence of kidney, spleen and lungs is the key. With the progress of treatment, edema, urinary protein from the dialectical, a whitish urine bubble is spleen deficiency, spleen qi can rise Kiyoharu; on the other hand, protein into tangible essence, Qi is not solid, then we start from the subtle loss of kidney qi, Qi solid is subtle reservoir, and achieved good the effect in the treatment of urinary protein. Finally, the deposition of immune complexes are often found in the renal pathological examination, immunoglobulin deposition has several cases in the case of IgA, IgM, or two, or both, Chinese medicine believes that the circulation is stagnation of blood stasis, we as a basis for promoting blood circulation and removing blood stasis in the proper use of refractory renal disease treatment, good treatment response.

In addition, the problem of kidney, our advice is not too tired to fill. Kidney is the congenital essence, not solid, protein loss, although the food is not solid, but the key reason lies in the fall, lung and Spleen Qi Lai life since only acquired fully, the spleen is acquired, Lung Qi of the whole body, the sufficiency of kidney qi and lung spleen closely instead, kidney gas is less effective to. Jianpibufei, temper is able-bodied, acquired enough, one hand can be the birth of the kidney and foot micro solid; on the other hand, spleen dampness, liquid water circulation and edema to self. Lung Sheng, and spleen and pectoral Qi, Wei Gu, the so-called righteousness, evil can not be dry, so the recurrence of nephropathy can be controlled. So, we are in remission of differentiation in nephropathy is mainly spleen and lung, and non kidney.

To reduce the clinical reports many TCM treatment of side effects, the most common is bone marrow inhibition, the western medicine group and reported the match, we found in the clinical treatment with traditional Chinese medicine, and the application of hormone or cyclophosphamide pulse therapy, the incidence rate of side effects is very low, even the most gastrointestinal reaction slight rarely occur, such as the use of other hormones after the red tongue, moss less performance, can be avoided, discusses in our other literature, no longer.

These are some of our experience in the treatment of refractory nephropathy in children, through clinical observation, found that the combination of traditional Chinese and Western medicine treatment of refractory nephropathy has obvious advantages. Of course, the advantages of traditional Chinese medicine in the treatment of this disease is believed to be far from limited, and more applications and efficacy of the treatment to be more clinical observation and research.

Reference

1 Durkan A, Hodson EM, Willis NS, et al. treatment nephrotic in children. The Database of Systematic Reviews. Cochrane 2006 Issue 2, for, syndrome

2 sun Qiang, Shen Ying.Meta analysis to evaluate the therapeutic effect of cyclophosphamide on children with nephrotic syndrome. Chinese Journal of Pediatrics.2006; 3 (44): 199 - 201

3 beam Ruqing, Lin Kailiang. Yishen Jianpi Huoxue treatment of refractory nephrotic syndrome in 60 cases. The new Chinese.2005; 8 (37):30 31

4 Yuan Bin, Liu Guangling et al. Study on the relationship between renal pathology and TCM syndrome differentiation in children with Henoch Schonlein purpura nephritis. Liaoning Journal of traditional Chinese medicine.2006; 8 (33): (in Chinese)

 

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