益气化瘀清热方序贯辨证治疗儿童难治性肾病综合征临床疗效观察  

Sequential Treatment with Syndrome Differentiation on Children’s Refractory Nephrotic Syndrome with Yiqi Huayu Qingre Prescription

作　　者：倪锦玉 翟文生[2] 李乐[2] 杨濛[2] 张秋月[2] NI Jin-yu;ZHAI Wen-sheng;LI Le;YANG Meng;ZHANG Qiu-yue(Henan University of Chinese Medicine,Zhengzhou 450046,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450099,China)

机构地区：[1]河南中医药大学,郑州450046 [2]河南中医药大学第一附属医院,郑州450099

出　　处：《中国实验方剂学杂志》2022年第4期116-123,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81273803,81873339);河南省中医药科学研究专项(2017ZY1011);河南省特色学科中医学学科建设项目(STS-ZYX-2017007)。

摘　　要：目的:评价益气化瘀清热方序贯辨证治疗儿童难治性肾病综合征的临床疗效。方法:将112例难治性肾病综合征患儿随机分为观察组和对照组,观察组57例,对照组55例。对照组给予泼尼松片联合他克莫司治疗,观察组在对照组基础上加用益气化瘀清热方序贯辨证治疗。观察两组治疗后的总有效率;观察两组患儿在治疗前、治疗4,8,16,24,32,40,52周后24小时尿蛋白定量(24 h UTP),血浆白蛋白(ALB),胆固醇(CHO),甘油三酯(TG)及小儿难治性肾病中医生存质量量表积分的变化;观察在治疗期间激素减停并持续到52周的患儿,比较其激素总疗程及总累积量。结果:观察组治疗后总有效率更高(Z=-2.052,P<0.05);与对照组比较,观察组在每个随访时间节点上24 h UTP均较低,ALB均较高(P<0.05,P<0.01);在治疗4,8,16周时CHO水平与对照组差异无统计学意义,在其余时间节点较对照组低(P<0.05,P<0.01);治疗4,8,16,40周时TG水平与对照组差异无统计学意义,在24,32,52周时较对照组低(P<0.05,P<0.01);观察组的激素总疗程更短(P<0.01),总累积量更少(P<0.01);随着随访时间节点的变化,观察组的中医生存质量量表总分均优于对照组(P<0.05,P<0.01),且治疗后观察组在四个维度(生理功能、独立性因素、社会因素、心理因素)的积分均较对照组高(P<0.05,P<0.01)。结论:益气化瘀清热方序贯辨证治疗儿童难治性肾病综合征临床疗效确切,在缩短激素总疗程、降低激素总累积量方面更有优势,能更好的提高患儿的生存质量。Objective:To evaluate the clinical efficacy of sequential syndrome differentiation of Yiqi Huayu Qingre prescription(YHQ)in the treatment of refractory nephrotic syndrome in children.Method:A total of 112 children with refractory nephrotic syndrome were randomly divided into an observation group(57 cases)and a control group(55 cases).The children in the control group were treated with prednisone tablets combined with tacrolimus,and those in the observation group were treated with YHQ by sequential syndrome differentiation on the basis of the control group.The total effective rates of the two groups after treatment were observed.The 24-hour urinary total protein(24 h UTP),plasma albumin(ALB),cholesterol(CHO),triglycerides(TG),and traditional Chinese medicine quality of life scale scores before treatment and after four weeks,eight weeks,16 weeks,24 weeks,32 weeks,40 weeks,and 52 weeks in the two groups were recorded.The total course of treatment and the total accumulation of hormones were compared among the children with reduced or no hormone treatment till 52 weeks during treatment.Result:The total effective rate in the observation group was higher(Z=-2.052,P<0.05).The observation group had lower 24 h UTP and higher ALB at each follow-up time point than the control group(P<0.05,P<0.01).At four weeks,eight weeks,and 16 weeks of treatment,there was no statistically significant difference in CHO between the observation group and the control group,and the observation group was lower than the control group in CHO at the rest of the time points(P<0.05,P<0.01).For TG,the observation group was not significantly different from the control group at four weeks,eight weeks,16 weeks,and 40 weeks of treatment,but lower at 24,32,and 52 weeks(P<0.05,P<0.01).The total treatment course of hormones in the observation group was shorter(P<0.01),with less total accumulation(P<0.01).At different follow-up time points,the total score of traditional Chinese medicine quality of life scale in the observation group was superior to that in th

关 键 词：难治性肾病 中医生存质量量表 益气化瘀清热方 儿童 序贯辨证 

分 类 号：R242[医药卫生—中医临床基础] R285.5[医药卫生—中医学]