芪蓟肾康颗粒治疗小儿紫癜性肾炎热毒血瘀证的临床研究  

The Clinical Research of Qiji Shenkang Granules in the Treatment of Children's Purpuric Nephritis with the Syndrome of Heat Toxin and Blood Stasis

作　　者：叶怀宇 宋奇 许枬[1] 张少卿[2] 张君[2] YE Huaiyu;SONG Qi;XU Nan;ZHANG Shaoqing;ZHANG Jun(Liaoning University of Traditional Chinese Medicine,Shenyang 110847 Liaoning,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110847 Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属医院,辽宁沈阳110847

出　　处：《中药新药与临床药理》2021年第9期1391-1395,共5页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：国家中医药管理局中医药行业专项研究项目(201507001-03)。

摘　　要：目的观察芪蓟肾康颗粒治疗小儿紫癜性肾炎(HSPN)热毒血瘀证的临床疗效及对免疫炎症因子的影响。方法将88例符合要求的患儿采用随机数字表法分为对照组(44)例和观察组(44)例。2组HSPN患儿均给予西医常规治疗措施,在此基础上,对照组口服芪蓟肾康模拟颗粒,观察组口服芪蓟肾康颗粒,2组患儿疗程均为3个月。观察2组患儿治疗前后热毒血瘀证积分、24 h尿蛋白定量(24 h-UP)、尿微量白蛋白(mAlb)、尿β2微球蛋白(β2-MG)、免疫球蛋白[免疫球蛋白A1(IgA1)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]、补体[补体(C)3、C4]、炎症因子[转化生长因子β1(TGF-β1)、白细胞介素17(IL-17)、肿瘤坏死因子α(TNF-α)、白细胞介素21(IL-21)]水平变化情况,评价治疗后2组患儿血尿、蛋白尿的转归情况和临床疗效。结果(1)对照组脱落、失访2例,剔除3例,最后完成研究39例;观察组脱落、失访2例,剔除2例,最后完成研究40例。(2)治疗后,2组患儿24 h-UP、mAlb、β2-MG水平和热毒血瘀证积分较治疗前明显降低(P<0.01),且治疗后观察组各指标水平均低于对照组(P<0.01)。(3)治疗后,2组患儿IgA1、IgG、IgM水平较治疗前明显下降(P<0.01),且治疗后观察组IgA1水平低于对照组(P<0.01)。(4)治疗后,2组患儿IL-17、TNF-α、IL-21和TGF-β1水平较治疗前明显下降(P<0.01),且治疗组各炎症因子改善水平均优于对照组(P<0.01)。(5)治疗后,观察组临床疗效优于对照组,差异有统计学意义(Z=2.109,P<0.05)。(6)治疗后,观察组蛋白尿消失率为61.76%(21/34),高于对照组的35.29%(12/34)(χ^(2)=4.769,P<0.05);观察组血尿和蛋白尿消失时间短于对照组(P<0.05)。结论在常规西医干预的基础上,采用芪蓟肾康颗粒治疗HSPN热毒血瘀患儿能提高患儿的临床疗效,减轻患儿肾损伤,并具有调节免疫炎症反应作用。Objective To observe the clinical efficacy of Qiji Shenkang granules in the treatment of children's purpuric nephritis(HSPN)with the syndrome of heat toxin and blood stasis and its influence on immune inflammatory factors.Methods The eighty-eight children who met the requirements were divided into a control group of 44 cases and an observation group of 44 cases by random number table method.Two groups of children with HSPN were given conventional western medicine treatment.Patients in the control group simultaneously took Qiji Shenkang simulated granules.Patients in the observation group took Qiji Shenkang granules orally at the same time.Treatment courses for both groups were 3 months.The score of heat toxin and blood stasis syndrome,the changes of 24 h-UP,mAlb,β2-MG,immunoglobulin(IgA1,IgG and IgM),complement(C3,C4),inflammatory factors(TGF-β1,IL-17,TNF-αand IL-21)before and after treatment were observed.The outcome of hematuria and proteinuria was evaluated.Results(1)In the control group,2 cases were lost,3 cases were eliminated,and 39 cases were completed;in the observation group,2 cases were lost,2 cases were eliminated,and 40 cases were completed.(2)The levels of 24 h-UP,mAlb,β2-MG,IgA1 and the scores of heat toxin and blood stasis syndrome of 2 groups decreased obviously after treatment.Besides the data in observation group were lower than those in the control group(P<0.01).(3)After treatment,the levels of IgA1,IgG,and IgM of the two groups significantly decreased(P<0.01),and the IgA1 level of the observation group was lower than that of the control group(P<0.01).(4)After treatment,the levels of IL-17,TNF-α,IL-21 and TGF-β1 of 2 groups dropped significantly(P<0.01).The improvement of inflammatory factors in the observation group was better than that in the control group(P<0.01).(5)After treatment,the clinical efficacy of the observation group was better than that of the control group,the difference was statistically significant(Z=2.109,P<0.05).(6)After treatment,the disappearance rate of proteinuria

关 键 词：紫癜性肾炎 芪蓟肾康颗粒 热毒血瘀证 免疫炎症因子 肾损伤 

分 类 号：R285.6[医药卫生—中药学]