知柏地黄丸加减治疗小儿紫癜性肾炎肝肾阴虚证的疗效观察  

Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children

作　　者：朱小石[1] 张渝[1] 邓俊超[1] 李运璧[1] 李建超[1] ZHU Xiao-shi;ZHANG Yu;DENG Jun-chao;LI Yun-bi;LI Jian-chao(Sichuan Provincial People's Hospital Under Sichuan Academy of Medical Sciences,Chengdu 610072,China)

机构地区：[1]四川省医学科学院,四川省人民医院,成都610072

出　　处：《中国实验方剂学杂志》2020年第17期89-94,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：2017年四川省卫生厅科研课题项目(130173)。

摘　　要：目的:观察知柏地黄丸加减治疗小儿紫癜性肾炎(HSPN)肝肾阴虚证的疗效及对免疫炎症反应和高凝状态的影响。方法:将120例符合要求的患儿按随机数字表法分为观察组和对照组各60例。对照组采用醋酸泼尼松龙片,1.5~2 mg·kg^-1·d^-1,分2次口服,4周后逐渐减量,改为隔日口服;注射用环磷酰胺,8~12 mg·kg^-1·d^-1,连续2 d静脉滴注,停2周,再行下1个疗程,共6个月。对照组口服大补阴丸,3 g/次,3次/d;观察组采用知柏地黄丸加减内服,1剂/d。连续治疗6个月。每月检测1次尿常规,记录血尿和蛋白尿消失时间和消失率,评价治疗前后24 h尿蛋白定量、尿微量白蛋白(mAlb)和尿β2微球蛋白(β2-MG)水平。进行治疗前后肝肾阴虚证评分;检测治疗前后T淋巴细胞亚群(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+),纤维蛋白原(FIB),D-二聚体(D-D),纤维蛋白降解产物(FDP),白细胞介素-2(IL-2),IL-4,IL-10和干扰素-γ(IFN-γ)水平。结果:观察组患儿临床疗效优于对照组(Z=2.078,P<0.05);观察组患儿血尿消失时间和蛋白尿消失时间均短于对照组(P<0.01);观察组蛋白尿消失率为90.48%(38/42),高于对照组的69.77%(30/43)(χ^2=5.694,P<0.05);观察组患儿24 h尿蛋白定量,mAlb和β2-MG均低于对照组(P<0.01);观察组患儿CD3^+,CD4^+水平和CD4^+/CD8^+均高于对照组(P<0.05),CD8^+低于对照组(P<0.05);观察组患儿治疗后FIB,D-D和FDP均低于对照组(P<0.01);观察组患儿IL-2,IFN-γ水平均高于对照组(P<0.05),IL-4,IL-10水平均低于对照组(P<0.05);观察组患儿中医证候疗效好于对照组(Z=2.106,P<0.05)。结论:在西医常规治疗的基础上,采用知柏地黄丸加减内服治疗HSPN肝肾阴虚证患儿,可促进蛋白尿和血尿的消失,缩短了病程,并可改善T淋巴细胞亚群,减轻炎症反应,纠正血液高凝状态,很好地提高临床疗效和中医证候疗效。Objective:To observe the clinical efficacy of modified Zhibo Dihuangwan on henochschonlein purpura nephritis with deficiency of liver and kidney yin in children(HSPN)and its effect on immune inflammatory response and hypercoagulable state.Method:Totally 120 patients were randomly divided into observation group(60 cases)and control group(60 cases)by random number table.Patients in two group was orally given prednisolone acetate tablets,1.5-2 mg·kg^-1·d^-1,2 times.Four weeks later,the drug was taken orally every other day,and the dosage decreased gradually after 4 weeks.Besides,patients in control group was intravenously dripped with cyclophosphamide,8-12 mg·kg^-1·d^-1,for 2 days,and stopped for 2 weeks before another treatment course.The treatment lasted for 6 months.In the control group,Dabuyin Wan was taken orally,3 g/time,3 times/d.Patients in observation group was also added with modified Zhibo Dihuang Wan,1 doe/day.The treatment lasted for 6 months.Urine routine was tested once a month,and disappearance time and rate of hematuria and albuminuria were recorded.The 24 h urine protein quantification,levels of microalbuminuria(mAlb)and urinaryβ2-microglobulin(β2-MG)were assessed before and after treatment.Furthermore,deficiency of liver and kidney Yin was scored,and levels of T lymphocyte subsets(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+),fibrinogen(FIB),D-dimer(D-D),fibrin degradation products(FDP),interleukin-2(IL-2),interferon-γ(IFN-γ),interleukin-4(IL-4),interleukin-10(IL-10)were detected.Result:The clinical efficacy in observation group was superior to that in control group(Z=2.078,P<0.05).Disappearance times of hematuria and albuminuria of children in observation group were shorter than those in control group(P<0.01).The disappearance rate of proteinuria in observation group was 90.48%(38/42),which was higher than 69.77%(30/43)in control group(χ^2=5.694,P<0.05).The 24 h urinary protein quantity,mAlb and levels ofβ2-MG,FIB,D-D and FDP in observation group were lower than those in control group(P<0.01).The leve

关 键 词：紫癜性肾炎 肝肾阴虚证 知柏地黄丸 T淋巴细胞亚群 炎症因子 凝血功能 

分 类 号：R289[医药卫生—方剂学] R272[医药卫生—中药学]