Observation on the curative effect of the prescription of Jianpi Yishen Huoxue Prescription in the treatment of atypical membranous nephropathy and the change of thrombus elastogram

OBJECTIVE: To observe the efficacy of traditional Chinese medicine (TCM) for invigorating the spleen, tonifying the kidney, and promoting blood circulation in the treatment of atypical membranous nephropathy and the changes in thromboelastography (TEG) before and after treatment. METHODS: Eighty patients diagnosed with atypical membranous nephropathy by renal biopsy at our hospital from June 2016 to June 2018 were selected. They were randomly divided into a conventional group (n=40) treated with prednisone combined with tacrolimus and an observation group (n=40) treated with the conventional group plus TCM for invigorating the spleen, tonifying the kidney, and promoting blood circulation. TEG indicators (reaction time R value, coagulation time K value, coagulation angle α, maximum thrombus elasticity MA value, coagulation index CI value) and 24-hour TEG were observed before treatment and 6 months after treatment in both groups. The clinical efficacy was evaluated and safety indicators were monitored by measuring 24-hour urinary protein quantification, serum albumin (Alb), total cholesterol (TC), and triglyceride (TG) levels. RESULTS: The total effective rate in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05). In the control group, R and K values ​​increased after treatment compared with before treatment, while a-angle, MA, and CI values ​​decreased, but the differences were not statistically significant (P>0.05). In the observation group, R and K values ​​increased after treatment compared with before treatment, while a-angle, MA, and CI values ​​decreased, and the differences were statistically significant (P<0.05). Comparing the R, K, a-angle, MA, and CI values ​​between the two groups after treatment, the observation group showed more significant improvement than the control group, and the difference was statistically significant (P<0.05). Alb increased in both groups after treatment compared with before treatment (P<0.05), and the increase was more significant in the observation group than in the control group (P<0.05). TC, TG, and 24-hour urinary protein quantification decreased in both groups after treatment compared with before treatment (P<0.05), and the 24-hour urinary protein quantification in the observation group decreased significantly. The improvement in h-urinary protein quantification was more significant in the group compared to the control group (P<0.05). No significant abnormalities were observed in blood routine tests or liver and kidney function in either group after treatment. CONCLUSION: The traditional Chinese medicine formula for strengthening the spleen, tonifying the kidneys, and promoting blood circulation can significantly improve the hypercoagulable state in patients with atypical membranous nephropathy and enhance clinical efficacy.