凉血解毒活血方治疗94例过敏性紫癜血热妄行证儿童的临床疗效评价
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摘要
目的:观察凉血解毒活血方治疗儿童过敏性紫癜(HSP)血热妄行证的近期和远期疗效,探讨其疗效特点。方法:收集94例HSP初治患儿,在西药常规治疗基础上,中医辨证主证为血热妄行,兼证包括:风热、湿热、热毒、瘀血,均服用凉血解毒活血方,并根据兼证加减。疗程1～3个月,停药后随访观察9个月。结果:血热妄行兼湿热、瘀血证(52例)和血热妄行兼热毒、瘀血证(17例)患儿的疗程明显长于血热妄行兼风热、瘀血证(25例)的疗程(P<0.05)。辨证治疗后血热妄行证不同兼证组均较本组治疗前瘀血积分显著降低(P<0.05),湿热、瘀血兼证组上焦湿热评分也较本组治疗前显著降低(P<0.05)。结论:凉血解毒活血方加减既有减少皮肤紫癜反复的近期疗效,又有降低紫癜性肾炎发生率、保护肾脏的远期疗效。在改善上焦湿热证和瘀血证方面作用突出。
Objective: To observe the short-term and long-term effects of Liangxue Jiedu Huoxue Formula on the treatment of Henoch-Sch?nlein purpura(HSP) with the syndrome of bleeding due to blood heat in children, and to explore its therapeutic features. Methods: Ninety-four children with HSP were treated on the basis of conventional treatment of western medicine. The main TCM syndrome dialectic of HSP was the syndrome of bleeding due to blood heat, and the accompanying symptoms included wind-heat, dampness-heat, heat-toxin, and blood stasis. Ninety-four children were treated with modified Liangxue Jiedu Huoxue Formula according to the changes of the accompanying symptoms. The course of treatment was 1-3 months, the patients were followed up for 9 months after drug withdrawal. Results: The treatment courses of the syndrome of bleeding due to blood heat with dampness-heat, blood stasis and with heat-toxin and blood stasis accompanying syndrome were significantly longer than those with wind-heat and blood stasis accompanying syndrome(P<0.05). Compared with those before treatment, the bleeding due to blood heat group's blood stasis scores were significantly reduced(P<0.05), and the dampress-heat and blood stasis group's clampressheat scores were significantly redued too(P<0.05). Conclusion: Modified Liangxue Jiedu Huoxue Formula has a short-term effect of reducing the recurrence of skin purpura and a long-term effect of reducing the incidence of Henoch-Sch?nlein purpura nephritis(HSPN). It plays an important role in improving the syndrome of dampness-heat in upper jiao and syndrome of blood stasis.
Objective: To observe the short-term and long-term effects of Liangxue Jiedu Huoxue Formula on the treatment of Henoch-Sch?nlein purpura(HSP) with the syndrome of bleeding due to blood heat in children, and to explore its therapeutic features. Methods: Ninety-four children with HSP were treated on the basis of conventional treatment of western medicine. The main TCM syndrome dialectic of HSP was the syndrome of bleeding due to blood heat, and the accompanying symptoms included wind-heat, dampness-heat, heat-toxin, and blood stasis. Ninety-four children were treated with modified Liangxue Jiedu Huoxue Formula according to the changes of the accompanying symptoms. The course of treatment was 1-3 months, the patients were followed up for 9 months after drug withdrawal. Results: The treatment courses of the syndrome of bleeding due to blood heat with dampness-heat, blood stasis and with heat-toxin and blood stasis accompanying syndrome were significantly longer than those with wind-heat and blood stasis accompanying syndrome(P<0.05). Compared with those before treatment, the bleeding due to blood heat group's blood stasis scores were significantly reduced(P<0.05), and the dampress-heat and blood stasis group's clampressheat scores were significantly redued too(P<0.05). Conclusion: Modified Liangxue Jiedu Huoxue Formula has a short-term effect of reducing the recurrence of skin purpura and a long-term effect of reducing the incidence of Henoch-Sch?nlein purpura nephritis(HSPN). It plays an important role in improving the syndrome of dampness-heat in upper jiao and syndrome of blood stasis.
引文
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[7]张亚楠,黄岩杰,岳上赛,等.透热转气理论在过敏性紫癜血热妄行重证治疗中的运用.中医杂志,2017,58(11):934
[8]张龙真,黄岩杰,张建,等.黄岩杰教授辨治小儿过敏性紫癜经验.中华中医药杂志,2015,30(9):3167-3169
[9]陈团营,朱珊,祝志朋.清热活血方药对过敏性紫癜肾炎患儿t-PA和PAI-1水平的影响.中华中医药杂志,2018,33(4):1574-1576
[10]黄岩杰,赵丽丽,李玉蕊,等.过敏性紫癜患儿瘀血及黏附分子sICAM-1、sVCAM-1表达水平的研究.中华中医药杂志,2012,27(9):43-45
[11]Jean-Claude Davin.Henoch-Sch?nlein Purpura Nephritis:Pathophysiology,Treatment,and Future Strategy.Clinical Journal of the American Society of Nephrology,2011,6(3):679-689
[2]Hahn D,Hodson E M,Willis N S,et al.Interventions for preventing and treating kidney disease in Henoch-Sch?nlein Purpura(HSP)(Review).The Cochrane database of systematic reviews,2015(8):CD005128
[3]黄岩杰,杨晓青,张笑聪,等.184例小儿紫癜性肾炎Ⅲ级病变的病理和中西医临床分型特点.中华中医药杂志,2014,29(10):3328
[4]中华医学会儿科学分会肾脏病学组.紫癜性肾炎的诊治循证指南(施行).中华儿科杂志,2009,47(12):911
[5]Saulsbury F T.Clinical update:Henoch-Sch?nlein purpura.The Lancet,2007,369(9566):976-978
[6]李贵.小儿肺虚证、脾虚证、血瘀证及肾虚证诊断标准.中国中西医结合杂志,2007,27(6):104
[7]张亚楠,黄岩杰,岳上赛,等.透热转气理论在过敏性紫癜血热妄行重证治疗中的运用.中医杂志,2017,58(11):934
[8]张龙真,黄岩杰,张建,等.黄岩杰教授辨治小儿过敏性紫癜经验.中华中医药杂志,2015,30(9):3167-3169
[9]陈团营,朱珊,祝志朋.清热活血方药对过敏性紫癜肾炎患儿t-PA和PAI-1水平的影响.中华中医药杂志,2018,33(4):1574-1576
[10]黄岩杰,赵丽丽,李玉蕊,等.过敏性紫癜患儿瘀血及黏附分子sICAM-1、sVCAM-1表达水平的研究.中华中医药杂志,2012,27(9):43-45
[11]Jean-Claude Davin.Henoch-Sch?nlein Purpura Nephritis:Pathophysiology,Treatment,and Future Strategy.Clinical Journal of the American Society of Nephrology,2011,6(3):679-689