复肾汤治疗小儿过敏性紫癜性肾炎（湿热瘀阻型）的临床研究

【作者】 林忠嗣；

【导师】 郭振武；

【作者基本信息】 辽宁中医药大学 ， 中医儿科学（专业学位）， 2013， 博士

【摘要】 目的：通过对复肾汤治疗湿热瘀阻型小儿过敏性紫癜性肾炎的临床研究，观察其临床疗效及用药安全性，从而为临床治疗小儿过敏性紫癜性肾炎提供更有效的治疗药物。方法：本次临床观察所选病例均为确诊为小儿过敏性紫癜性肾炎（血尿和/或蛋白尿型）的患儿，采用随机对照的原则将60例入选病例随机分为中医治疗组（以下简称治疗组）及雷公藤对照组（以下简称对照组）两组，每组各30例。两组都接受相同的基础治疗，包括注意脱敏饮食、避免剧烈运动、注意预防感冒，另外均口服VC、VE、芦丁、潘生丁等基础药物，对照组在基础治疗之上口服雷公藤多苷片，1mg/kg·d，分3次饭后口服；治疗组在基础治疗的同时，采用导师经验中药方复肾汤口服。两组均以1个月为1个疗程，观察3个疗程。治疗结束后，观察临床疗效，并对所有未脱落的病例进行为期3个月的随访观察，总结临床结果。结果：1.两组治疗前的一般资料、临床症状、体征、中医证候积分、尿红细胞计数、24小时蛋白量及其它所选观察的理化检验指标均无显著性差异，经统计学分析（P＞0.05），具有可比性。2.两组治疗前后疾病疗效愈显率及临床总有效率的比较中，结果显示：治疗组愈显率为64.3%，临床总有效率为92.9%，对照组愈显率为33.3%，临床总有效率为70.4%，两组相比，无论是在愈显率方面还是在临床总有效率方面，均具有显著性差异（P＜0.05）。统计结果分析可知，治疗组疗效优于对照组。3.两组治疗前后中医证候总积分的比较中，结果显示：治疗组的治疗前积分为11.63±2.42，治疗后积分为2.58±1.62，对照组的治疗前积分为11.37±2.61，治疗后积分为6.62±2.41，两组在治疗后与治疗前相比，存在显著性差异（P＜0.05），说明治疗组与对照组的中医证候积分均明显降低，治疗后优于治疗前。治疗后治疗组的中医证候总积分与对照组治疗后中医证候总积分相比，有显著性差异（P＜0.05），说明治疗组在改善中医证候方面优于对照组。两组治疗前后中医证候疗效愈显率及临床总有效率的比较中，结果显示：治疗组愈显率为85.7%，临床总有效率为100.0%，对照组愈显率为51.9%，临床总有效率为81.5%，两组相比，无论是在愈显率方面还是在临床总有效率方面，经统计学对比，均具有显著性差异（P＜0.05）。统计结果分析可知，治疗组疗效优于对照组。4.两组治疗前后尿红细胞计数的比较中，结果显示：两组在治疗后与治疗前相比，存在显著性差异（P＜0.05），说明治疗组与对照组的尿红细胞计数均明显降低，治疗后优于治疗前。治疗后治疗组的尿红细胞计数与对照组治疗后尿红细胞计数相比有显著性差异（P＜0.05），说明治疗组在减少紫癜性肾炎尿红细胞计数方面优于对照组。两组治疗前后24小时尿蛋白定量的比较中，结果显示：两组在治疗后与治疗前相比，存在显著性差异（P＜0.05），说明治疗组与对照组的24小时尿蛋白定量均明显降低，治疗后优于治疗前。但治疗后治疗组的24小时尿蛋白定量与对照组治疗后24小时尿蛋白定量相比无显著性差异（P＞0.05），说明治疗组在减少紫癜性肾炎24小时尿蛋白定量方面没有明显优势。在本次临床观察中，治疗组在对降低尿β2-微球蛋白、尿微量白蛋白，调节免疫球蛋白IgA、IgG以及降低血小板计数、改善血液凝血功能等方面均明显优于对照组，经统计学分析，存在显著性差异（P＜0.05）。5.观察两组治疗后的复发率方面比较，结果显示：治疗组的随访复发率为5.6%，对照组的随访复发率为33.3%，存在统计学差异（P＜0.05）；在两组治疗期间，治疗组不良反应发生例数明显低于对照组，两组相比，存在统计学差异（P＜0.05）。结论：1.临床表现血尿和/或蛋白尿为主的小儿过敏性紫癜性肾炎通过临床中医辨证属湿热瘀阻型者采用中药复肾汤治疗，具有较好地减少尿红细胞及尿蛋白的作用。2.复肾汤能明显改善湿热瘀阻型过敏性紫癜性肾炎的中医临床证候，且无明显副作用。但复肾汤对减少尿蛋白的作用与雷公藤多苷片相比没有明显优势，雷公藤多苷片虽然有较好的减少尿蛋白的作用，但在减少紫癜肾血尿症状及中医临床证候方面不如中药复肾汤，且有一定的副作用。3.通过观察复肾汤对过敏性紫癜性肾炎治疗前后免疫球蛋白IgA、IgG、IgM以及血小板及凝血功能的影响，表明本病的作用机制可能与炎症反应、免疫功能、血液高凝状态等因素有关，但具体机制如何以及是否存在其它作用机制有待于今后进一步深入研究。更多还原

【Abstract】 Objective: By heat treating complex renal blood stasis purpura nephritisclinical research, clinical efficacy and safety of drugs, so as to clinicaltreatment of children with allergic purpura nephritis provide more effectivetreatments.Methods: The clinical observation of selected cases were diagnosed as purpuranephritis (hematuria and/or proteinuria) in children, using the principlesof randomized60patients enrolled were randomly divided into traditionalChinese medicine treatment group (less referred to the treatment group) andtriptolide group (hereinafter referred to as the control group) two groups, eachof30cases. Both groups received the same basic treatment, including attentiondesensitization diet, avoid strenuous exercise, pay attention to prevent colds,while both oral VC, VE, rutin, dipyridamole and other basic drugs, the controlgroup on the basis of the treatment of oral TWP tablets,1mg/kg d,3timesafter oral administration; basic treatment in the treatment group, while theexperience of using the tutor prescription Fushenning decoction. The two groupsare one month of a course of treatment, observation of three courses. Aftertreatment, the clinical effect, and all of the cases did not fall off athree-month follow-up observations, summarize clinical outcomes.Results:1.General information before treatment, clinical symptoms, signs, symptom score,urine red blood cell count,24hours and the amount of protein and chemicalexamination of other selected indicators observed no significant differencesin the statistical analysis (P>0.05), comparable.2.before and after treatment efficacy disease markedly effective rate and totaleffective comparison, the results show: the treatment group markedly effectiverate was64.3%, total effective rate was92.9%, markedly effective rate was33.3% in the control group, the clinical The total effective rate was70.4%, comparedthe two groups, both in the markedly effective rate or the total clinicalefficiency, there were significant differences (P <0.05). Statistical analysisshows that the treatment group than the control group.3.before and after treatment syndromes total credit comparison, the resultsshowed that: the treatment group treatment score was11.63±2.42, aftertreatment score was2.58±1.62, control group treatment score was11.37±2.61, after treatment Points to6.62±2.41, both groups after treatmentcompared with before treatment, there was a significant difference (P <0.05),indicating that the treatment group and the control group were symptom scoredecreased significantly after treatment than before treatment. After treatment,the total score of TCM and the control group after treatment, TCM total score,compared with a significant difference (P <0.05), indicating that the treatmentgroup improved TCM superior to the control group.Before and after treatment TCM syndromes markedly effective rate and totaleffective comparison, the results show: the treatment group markedly effectiverate was85.7%, total effective rate was100.0%, markedly effective rate was51.9%in the control group, the clinical The total effective rate was81.5%,compared the two groups, both in the markedly effective rate or the total clinicalefficiency, the statistical comparison, there were significant differences (P<0.05). Statistical analysis shows that the treatment group than the controlgroup.4.red blood cell count in urine before and after treatment comparison, theresults show: the two groups after treatment compared with before treatment,there was a significant difference (P <0.05), indicating that the treatment groupand the control group were significantly lower red blood cell count in urineafter treatment than before treatment. After treatment of urinary red blood cellcount after treatment with the control group compared to urinary red blood cellcount was significant difference (P <0.05), indicating that the treatment grouppurpura nephritis urinary red blood cell count than the control group. Before and after treatment of24-hour urinary protein excretion comparison, theresults show: the two groups after treatment compared with before treatment,there was a significant difference (P <0.05), indicating that the treatment groupand the control group,24-hour urinary protein excretion were significantlydecreased after treatment than before treatment. However, the treatment groupof24-hour urinary protein excretion compared with the control group aftertreatment,24-hour urinary protein excretion showed no significant difference(P>0.05), indicating that the treatment group purpura nephritis in24-hoururinary protein excretion there was no obvious advantage.In this clinical observation, the treatment group to reduce urinaryβ2-microglobulin, urinary albumin, immune globulins IgA, IgG and reducedplatelet count, improve blood clotting function were significantly better thanthe control group, the statistical analysis, there was a significant difference(P <0.05).5.were observed recurrence rate after treatment, the results show: the treatmentgroup follow-up recurrence rate was5.6%in the control group, the recurrencerate was33.3%follow-up, there is a statistically significant difference (P<0.05); patients in both groups children during treatment, the treatment groupnumber of cases of adverse events was significantly lower than the control group,two groups, there is a statistically significant difference (P <0.05).Conclusion:1.Clinical manifestations hematuria and/or proteinuria dominated purpuranephritis through clinical TCM is hot and humid stasis type by using traditionalChinese medicine decoction self Fushenning has better reduce urinary proteinin red blood cells and the role of urinary.2.Fushenning soup can significantly improve heat stasis type allergic purpuranephritis TCM clinical syndromes, and no significant side effects. ButFushenning Tang role in reducing urinary protein chip TWP compared with noobvious advantage, although Tripterygium glycosides tablet better to reduce the role of protein in the urine, but in purpura renal hematuria syndrome symptomsand clinical medicine not as good as traditional Chinese medicine complex kidneysoup, there are certain side effects.3.by observing complex Decoction on purpura in children before and aftertreatment of renal immunoglobulin IgA, IgG, IgM, and platelet count andcoagulation function, suggesting that the mechanism of the disease may be relatedto immune function, hypercoagulable states and other factors, However, thespecific role of how and whether there are other mechanisms need to be in thefuture further research.更多还原