益气固肾活血汤序贯辨证治疗儿童难治性肾病综合征  

Yiqi Gushen Huoxue Decoction in Sequential Syndrome Differentiation Treatment of Refractory Nephrotic Syndrome in Children

作　　者：肖景霞[1] 李广[2] 翟文生[2] XIAO Jingxia;LI Guang;ZHAI Wensheng(Zhengzhou First People′s Hospital,Zhengzhou Henan China 450004;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou Henan China 450000)

机构地区：[1]郑州市第一人民医院,河南郑州450004 [2]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中医学报》2022年第8期1786-1791,共6页Acta Chinese Medicine

基　　金：中国民族医药学会科研项目(2020ZY269-400655)。

摘　　要：目的:观察益气固肾活血汤序贯辨证治疗儿童难治性肾病综合征(refractory nephropathy syndrome,RNS)的临床疗效及其抗炎、抗凝作用机制。方法:98例RNS患儿随机分为观察组(49例,脱失3例,剔除2例,最后完成44例)和对照组(49例,脱失4例,剔除0例,最后完成45例)。对照组给予醋酸泼尼松片+他克莫司胶囊治疗;观察组在对照组治疗基础上给予益气固肾活血汤。两组均给予序贯治疗,均治疗12周。比较两组患者治疗前后理化指标[24 h尿蛋白定量(24 h urine protein quantity,24 hUTP)、血清白蛋白(albumin,ALB)、血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)]、炎症指标[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、白细胞介素-6(interleukin-6,IL-6)和IL-17]、纤维蛋白原(fibrinogen,Fib),中医证候积分及两组临床疗效、中医证候疗效。结果:治疗后,两组患儿24 hUTP、Scr、BUN水平和中医证候积分均低于本组治疗前(P<0.05),且观察组低于同期对照组,差异均有统计学意义(P<0.05);治疗后,两组患儿ALB水平高于本组治疗前(P<0.05),且观察组高于同期对照组,差异有统计学意义(P<0.05)。治疗后,两组患儿TNF-α、TGF-β1、IL-6和IL-17水平均低于本组治疗前(P<0.05),且观察组均低于同期对照组,差异均有统计学意义(P<0.05)。治疗后,两组患儿Fib水平均低于本组治疗前(P<0.05),且观察组低于同期对照组,差异均有统计学意义(P<0.05)。治疗后,观察组完全缓解率为62.22%(28/45),高于对照组的38.64%(17/44),差异有统计学意义(χ^(2)=4.951,P<0.05)。观察组复发率为4.55%(2/44),低于对照组的22.50%(9/40),经确切概率法检验,组间差异有统计学意义(P<0.05)。观察组中医证候疗效有效率为100%(45/45),高于对照组的81.82%(36/44),差异有统计学意义(χ^(2)=6.901,P<0.01)。结论:益气固肾活血汤治疗儿童RNS临床疗效、中医证Objective:To observe the clinical efficacy of Yiqi Gushen Huoxue Decoction in treatment of children with refractory nephropathy syndrome(RNS) by sequential syndrome differentiation and its anti-inflammatory and anticoagulant mechanisms.Methods:98 children with RNS were randomly divided into the observation group(49 cases,3 cases were dropped,2 cases were eliminated,and 44 cases were completed) and the control group(49 cases,4 cases were lost,0 cases were eliminated,and 45 cases were completed).The control group was given prednisone acetate tablets+tacrolimus capsules for treatment,while the observation group was given Yiqi Gushen Huoxue Decoction on the basis of the treatment of the control group.Both groups were given sequential treatment for 12 weeks.The physicochemical indexes [24 h urine protein quantity(24 h UTP),serum albumin(ALB),serum creatinine(Scr),blood urea nitrogen(BUN)],inflammatory indicators [tumor necrosis factor-α(TNF-α),transforming growth factor-β1(TGF-β1),interleukin-6(interleukin-6,IL-6) and IL-17],fibrinogen(Fib),TCM syndrome scores,the clinical efficacy of the two groups,and TCM syndrome efficacy were compared before and after treatment.Results:After treatment,the 24 hUTP,Scr,BUN levels,and TCM syndrome scores of the two groups were lower than those before treatment in the same group(P<0.05),and the observation group was lower than the control group at the same period,and the difference was statistically significant(P<0.05).After treatment,the levels of ALB in the two groups were higher than those before treatment in the same group(P<0.05),and the observation group was higher than that in the control group at the same period,and the difference was statistically significant(P<0.05).After treatment,the levels of TNF-α,TGF-β1,IL-6,and IL-17 in the two groups were lower than those before treatment in the same group(P<0.05),and the observation group was lower than those in the control group at the same period,and the differences were statistically significant(P<0.05).After treatment,the l

关 键 词：儿童难治性肾病综合征 益气固肾活血汤 肺脾肾气虚证 瘀血阻滞证 肾功能 炎症因子 纤维蛋白原 

分 类 号：R272.6[医药卫生—中医儿科学]