Clinical Efficacy of Modified Huangqi Chifengtang in Treatment of IgA Nephropathy Patients and Exploration of Dose-effect Relationship of Astragali Radix
Objective:To explore the dose-effect relationship and safety of high,medium,and low doses of raw Astragali Radix in the modified Huangqi Chifengtang(MHCD)for treating proteinuria in immunoglobulin A(IgA)nephropathy,and to provide scientific evidence for the clinical use of high-dose Astragali Radix in the treatment of proteinuria in IgA nephropathy.Methods:A total of 120 patients with IgA nephropathy,diagnosed with Qi deficiency and blood stasis combined with wind pathogen and heat toxicity,were randomly divided into a control group and three treatment groups.The control group received telmisartan combined with a Chinese medicine placebo,while the treatment groups were given telmisartan combined with MHCD containing different doses of raw Astragali Radix(60,30,15 g).Each group contained 30 patients,and the treatment period was 12 weeks.Changes in 24-hour urinary protein(24 hUTP),traditional Chinese medicine(TCM)syndrome scores,effective rate,and renal function were observed before and after treatment.Safety was assessed by monitoring liver function and blood routine.Results:After 12 weeks of treatment,24 hUTP significantly decreased in the high,medium,and low-dose groups,as well as the control group(P＜0.05,P＜0.01).The TCM syndrome scores in the high,medium,and low-dose groups also significantly decreased(P＜0.01).Comparisons between groups showed that the 24 hUTP in the high-dose group was significantly lower than in the medium,low-dose,and control groups(P＜0.05,P＜0.01),and the 24 hUTP in the medium-dose group was significantly lower than in the control group(P＜0.05).The TCM syndrome scores in the high and medium-dose groups were significantly lower than in the low-dose and control groups(P＜0.05,P＜0.01).The total effective rates for proteinuria in the high,medium,low-dose,and control groups were 92.59％(25/27),85.19％(23/27),60.71％(17/28),and 57.14％(16/28),respectively.The effective rates in the high and medium-dose groups were significantly higher than in the low-dose and control groups(x2=13.185,P＜0.05,P＜0.01).The effective rates for TCM syndrome scores in the high,medium,low-dose,and control groups were 88.89％(24/27),81.48％(22/27),71.43％(20/28),and 46.43％(13/28),respectively.The efficacy of TCM syndrome scores in the high and medium-dose groups was significantly higher than in the control group(x2=14.053,P＜0.01).Compared with pre-treatment values,there was no statistically significant difference in eGFR and serum creatinine in the high and medium-dose groups.However,eGFR significantly decreased in the low-dose and control groups after treatment(P＜0.05),and serum creatinine levels increased significantly in the control group(P＜0.05).No statistically significant differences were observed in urea nitrogen,uric acid,albumin,total cholesterol,triglycerides,liver function,and blood routine before and after treatment in any group.Conclusion:There is a dose-effect relationship in the treatment of IgA nephropathy with high,medium,and low doses of raw Astragali Radix in MHCD.The high-dose group exhibited the best therapeutic effect and good safety profile.
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