加味犀角地黄汤辨治儿童紫癜性肾炎血热夹瘀证的临床观察
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摘要
目的:观察加味犀角地黄汤辨治儿童紫癜性肾炎血热夹瘀证的临床疗效及对炎症因子和凝血功能的影响。方法:将122例患者采用随机数字表法分为对照组60例和观察组62例。对照组口服醋酸泼尼松龙片,1. 5～2 mg·kg~(-1)·d~(-1),4周后改为隔日口服,经4周后再逐渐减量;口服双嘧达莫片,3～5 mg·kg~(-1)·d~(-1);口服复方芦丁片,1片/次,3次/d。观察组在对照组治疗的基础上采用加味犀角地黄汤辨证内服,1剂/d。两组均连续治疗12周。进行治疗前后血热夹瘀证评分;检测治疗前后尿β2微球蛋白(β2-MG),24 h尿蛋白定量(24 h UmAlb),尿微量蛋白(mAlb),胱抑素C(CysC),血小板计数(PLT),血浆凝血酶原时间(PT),活化部分凝血酶原时间(APTT),白细胞介素-2(IL-2),IL-4,IL-10,肿瘤坏死因子-α(TNF-α),血管性假性血友病因子(vWF),血小板活化因子(PAF),血栓调节蛋白(TM),血浆纤维蛋白原(FIB),尿红细胞(RBC)和尿蛋白(PRO)情况。结果:观察组临床疗效总有效率为95. 16%,高于对照组的81. 54%(χ~2=5. 466,P <0. 05);观察组中医证候总有效为96. 77%,高于对照组的75%(χ~2=12. 052,P <0. 01);治疗后观察组患儿β2-MG,24 h UmAlb,mAlb,CysC水平均明显低于对照组(P <0. 01);治疗后两组患者PT均较治疗前延长(P <0. 05),观察组延长更为显著(P <0. 05);治疗后观察组FIB水平低于对照组(P <0. 05);观察组患儿血清IL-4,IL-10和TNF-α水平均低于对照组,IL-2水平高于对照组(P <0. 01);观察组患儿vWF,PAF和TM水平均低于对照组(P <0. 01)。结论:在常规激素治疗的基础上,服用加味犀角地黄汤辨治HSPN血热夹瘀证患儿,可起到护保肾功能,减轻蛋白尿、血尿,有明显的临床疗效,并具有抗炎、改善凝血功能的作用。
Objective: To observe the clinical effect of Jiawei Xijiao Dihuang Tang on Henoch-schonlein purpura nephritis of children with blood heat and stasis syndrome and the inflammatory factors and coagulation function. Method: One hundred and twenty-two patients were divided into control group( 60 cases) and observation group( 62 cases) by random number table. Patients in control group got prednisolone acetate tablets every day,1. 5-2 mg·kg~(-1)·d~(-1),after 4 weeks,of the treatment,and the 4 weeks dosage decreased progressively.Patients in control group also got dipyridamole tablets,3-5 mg·kg~(-1)·d~(-1),and compound rutin tablets,1 tablet/day,3 times/days. In addition to the therapy of control group,patients in observation group were also given Jiawei Xijiao Dihuang Tang,1 dose/day. And one course of treatment was 12 weeks. Before and after treatment,blood heat and stasis syndrome were graded. And levels of urinary β2 microglobulin( β2-MG),24-hour urine protein quantitative( 24 h UmAlb),microalbuminuria( mAlb),cystatin C( CysC),platelet count( PLT),plasma prothrombin time( PLT), plasma prothrombin time( PT), activated partial thromboplastin time( APTT),interleukins-2( IL-2),IL-4,IL-10,tumor necrosis factor-α( TNF-α),von willebrand factor( vWF),platelet activating factor( PAF),thrombomodulin( TM),plasma fibrinogen( FIB),urine RBC and urine protein( PRO)were detected. Result: The total clinical effect in observation group was 95. 16%,which was higher than 81. 54%in control group( χ2= 5. 466,P < 0. 05). And the total symptoms of traditional Chinese medicine( TCM) was96. 77%,which was higher than 75% in control groups( χ2= 12. 052,P < 0. 01). After treatment,levels of β2-MG,24 h UmAlb,mAlb and CysC were higher than those in control groups( P < 0. 01). And PT in both groups prolonged,particularly in observation group( P < 0. 05). Level of FIB in observation group was lower than that in control groups( P < 0. 05). And levels of IL-4,IL-10,TNF-α and vWF,PAF and TM were lower than those in control groups,but level of IL-2 was higher than that in control groups( P < 0. 01). Conclusion: In addition to the hormone therapy,Jiawei Xijiao Dihuang Tang can protect renal function,relieve symptoms of proteinuria and hematuria,with the effects of resisting inflammation and alleviating coagulation function.
Objective: To observe the clinical effect of Jiawei Xijiao Dihuang Tang on Henoch-schonlein purpura nephritis of children with blood heat and stasis syndrome and the inflammatory factors and coagulation function. Method: One hundred and twenty-two patients were divided into control group( 60 cases) and observation group( 62 cases) by random number table. Patients in control group got prednisolone acetate tablets every day,1. 5-2 mg·kg~(-1)·d~(-1),after 4 weeks,of the treatment,and the 4 weeks dosage decreased progressively.Patients in control group also got dipyridamole tablets,3-5 mg·kg~(-1)·d~(-1),and compound rutin tablets,1 tablet/day,3 times/days. In addition to the therapy of control group,patients in observation group were also given Jiawei Xijiao Dihuang Tang,1 dose/day. And one course of treatment was 12 weeks. Before and after treatment,blood heat and stasis syndrome were graded. And levels of urinary β2 microglobulin( β2-MG),24-hour urine protein quantitative( 24 h UmAlb),microalbuminuria( mAlb),cystatin C( CysC),platelet count( PLT),plasma prothrombin time( PLT), plasma prothrombin time( PT), activated partial thromboplastin time( APTT),interleukins-2( IL-2),IL-4,IL-10,tumor necrosis factor-α( TNF-α),von willebrand factor( vWF),platelet activating factor( PAF),thrombomodulin( TM),plasma fibrinogen( FIB),urine RBC and urine protein( PRO)were detected. Result: The total clinical effect in observation group was 95. 16%,which was higher than 81. 54%in control group( χ2= 5. 466,P < 0. 05). And the total symptoms of traditional Chinese medicine( TCM) was96. 77%,which was higher than 75% in control groups( χ2= 12. 052,P < 0. 01). After treatment,levels of β2-MG,24 h UmAlb,mAlb and CysC were higher than those in control groups( P < 0. 01). And PT in both groups prolonged,particularly in observation group( P < 0. 05). Level of FIB in observation group was lower than that in control groups( P < 0. 05). And levels of IL-4,IL-10,TNF-α and vWF,PAF and TM were lower than those in control groups,but level of IL-2 was higher than that in control groups( P < 0. 01). Conclusion: In addition to the hormone therapy,Jiawei Xijiao Dihuang Tang can protect renal function,relieve symptoms of proteinuria and hematuria,with the effects of resisting inflammation and alleviating coagulation function.
引文
[1]中华医学会儿科学分会肾脏学组.紫癜性肾炎诊治循证指南(2016)[J].中华儿科杂志,2017,55(9):647-653.
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[4]秦艳巧,袁斌.儿童过敏性紫癜性肾炎中医药治疗进展[J].辽宁中医药大学学报,2016(5):139-142.
[5]张保国,程铁峰,刘庆芳.犀角地黄汤药效研究及临床新用[J].中成药,2009,31(12):1919-1921.
[6]闫红娟,路欣.儿童紫癜性肾炎外周血炎症因子水平与病情严重程度相关性的临床研究[J].中国卫生检验杂志,2013,23(4):1038-1039.
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[8]翁维维,赵颖玲,翁志媛,等.吗替麦考酚酯联合激素治疗重症紫癜性肾炎的效果[J].广东医学,2018,39(8):1232-1235.
[9]孙智才,杨华彬.免疫抑制剂治疗儿童紫癜性肾炎的进展[J].实用药物与临床,2014,17(3):350-353.
[10]周添标,覃远汉,苏丽娜,等.雷公藤总苷和糖皮质激素治疗紫癜性肾炎的Meta分析[J].中华实用儿科临床杂志,2010,25(17):1308-1312.
[11]刘春莹.紫癜性肾炎中西医结合临证体会[J].陕西中医药大学学报,2017,40(5):26-27.
[12]刘洪,杨敬,黎颖,等.紫癜性肾炎的病因病机及治法探讨[J].中国中医基础医学杂志,2016,22(11):1566-1568.
[13]季建敏,史锁芳,董筠.周仲瑛"瘀热血溢学说"论治过敏性紫癜[J].中国中医急症,2009,18(9):1463-1464.
[14]李辉,袁斌,夏正坤,等.儿童紫癜性肾炎196例中医证候分型与肾脏病理分级相关性研究[J].中国中西医结合儿科学,2011,3(5):463-464.
[15]朱丽丹,钱茜茜,温怀凯.尿系列微量蛋白测定在儿童肾脏损伤中的意义[J].中国卫生检验杂志,2011,21(5):1233-1234.
[16]李锦芬,李晓忠.血清胱抑素C纤维蛋白原及24 h尿蛋白定量对紫癜性肾炎儿童肾损伤程度的评估效果[J].安徽医学,2018,39(2):186-189.
[17]丁艳,刘玲,董宗祈.过敏性紫癜肾炎患儿血清细胞因子水平变化及意义[J].临床儿科杂志,2005,23(9):643-645.
[18]李宸宇,孙晓红,王丽,等.血栓调节蛋白的研究进展[J].中国临床药理学与治疗学,2015,20(4):445-449.
[19]蔡晋,徐美玉.紫癜性肾炎患者血浆TM,v WF和IL-8水平的变化[J].江苏医药,2012,38(14):1646-1648.
[20]刘静,鲁阳,陆彪.血小板活化因子及其乙酰水解酶与儿童紫癜性肾炎的关系[J].宁夏医科大学学报,2017,39(6):714-717.
[2]吴秀丽,彭英,岳新爱,等.过敏性紫癜性肾炎发病机制的研究进展[J].华西医学,2014,29(6):1167-1170.
[3]王新良,戎赞华.紫癜性肾炎的诊断与治疗[J].中华实用儿科临床杂志,2011,26(17):1381-1384.
[4]秦艳巧,袁斌.儿童过敏性紫癜性肾炎中医药治疗进展[J].辽宁中医药大学学报,2016(5):139-142.
[5]张保国,程铁峰,刘庆芳.犀角地黄汤药效研究及临床新用[J].中成药,2009,31(12):1919-1921.
[6]闫红娟,路欣.儿童紫癜性肾炎外周血炎症因子水平与病情严重程度相关性的临床研究[J].中国卫生检验杂志,2013,23(4):1038-1039.
[7]中华中医药学会发布.中医儿科常见病诊疗指南[M].北京:中国中医药出版社,2012:175-178.
[8]翁维维,赵颖玲,翁志媛,等.吗替麦考酚酯联合激素治疗重症紫癜性肾炎的效果[J].广东医学,2018,39(8):1232-1235.
[9]孙智才,杨华彬.免疫抑制剂治疗儿童紫癜性肾炎的进展[J].实用药物与临床,2014,17(3):350-353.
[10]周添标,覃远汉,苏丽娜,等.雷公藤总苷和糖皮质激素治疗紫癜性肾炎的Meta分析[J].中华实用儿科临床杂志,2010,25(17):1308-1312.
[11]刘春莹.紫癜性肾炎中西医结合临证体会[J].陕西中医药大学学报,2017,40(5):26-27.
[12]刘洪,杨敬,黎颖,等.紫癜性肾炎的病因病机及治法探讨[J].中国中医基础医学杂志,2016,22(11):1566-1568.
[13]季建敏,史锁芳,董筠.周仲瑛"瘀热血溢学说"论治过敏性紫癜[J].中国中医急症,2009,18(9):1463-1464.
[14]李辉,袁斌,夏正坤,等.儿童紫癜性肾炎196例中医证候分型与肾脏病理分级相关性研究[J].中国中西医结合儿科学,2011,3(5):463-464.
[15]朱丽丹,钱茜茜,温怀凯.尿系列微量蛋白测定在儿童肾脏损伤中的意义[J].中国卫生检验杂志,2011,21(5):1233-1234.
[16]李锦芬,李晓忠.血清胱抑素C纤维蛋白原及24 h尿蛋白定量对紫癜性肾炎儿童肾损伤程度的评估效果[J].安徽医学,2018,39(2):186-189.
[17]丁艳,刘玲,董宗祈.过敏性紫癜肾炎患儿血清细胞因子水平变化及意义[J].临床儿科杂志,2005,23(9):643-645.
[18]李宸宇,孙晓红,王丽,等.血栓调节蛋白的研究进展[J].中国临床药理学与治疗学,2015,20(4):445-449.
[19]蔡晋,徐美玉.紫癜性肾炎患者血浆TM,v WF和IL-8水平的变化[J].江苏医药,2012,38(14):1646-1648.
[20]刘静,鲁阳,陆彪.血小板活化因子及其乙酰水解酶与儿童紫癜性肾炎的关系[J].宁夏医科大学学报,2017,39(6):714-717.