【作者】 戴路露；

【导师】 吴玉斌；

【作者基本信息】 中国医科大学 ， 儿科学， 2010， 硕士

【摘要】 目的观察槐杞黄颗粒辅助治疗肾病综合征患儿对淋巴细胞亚群、免疫球蛋白及感染次数的影响。方法选择2008年1月1日—2008年12月31日小儿肾脏内科住院的原发性肾病综合征(PNS)患儿101例,其中男60例,女41例,年龄1-14岁,随机分为两组,激素联合应用槐杞黄颗粒(A组)62例,单独服用激素(B组)39例,正常对照(C组)为本院正常体检儿童22例,其中男13例,女9例。分别于治疗前(A0、B0)和治疗3月(A3、B3)、6月(A6、B6)检测患儿的淋巴细胞亚群、免疫球蛋白及记录感染次数、肾病复发次数和服药副作用(每例观察6月)。结果1、肾病治疗前AO组(62例)、B0组(39例)CD8+均明显高于C组(P<0.05),CD4+明显低于C组(22例)(P<0.05),CD4+／CD8+比值明显降低甚至倒置(P<0.05),NK细胞明显低于C组(P<0.01),IgA与IgG明显低于C组(P<0.05,P<0.01)。2、治疗3个月,总T细胞：A3组(39例)高于A0、B3和C组(P<0.05),B3组变化不明显；CD8+：A3组与A0、B3组无异,仍高于C组(P<0.05),B3组与B0组无异,更高于C组(P<0.01)；CD4+：A3组与A0、C组无异,高于B3组(P<0.01),B3组与B0组无异,仍低于C组(P<0.01)；CD4+／CD8+:A3组与AO组无异,高于B3组(P<0.05),低于C组(P<0.05),B3组与B0组无异,仍低于C组(P<0.01)；NK细胞：A3组高于A0组(P<0.01),高于B3组(P<0.05),与C组无异,B3组高于B0组(P<0.01),与C组无异；总B细胞：A3组低于A0、B3和C组(P<0.01),B3组低于B0组(P<0.05),与C组无异；IgA:A3组与A0、B3组无异,低于C组(P<0.05),B3组与B0组无异,低于C组(P<0.05)；IgG：A3组高于A0组(P<0.01),与B3组无异,仍低于C组(P<0.01),B3组高于B0组(P<0.01),仍低于C组(P<0.01)；IgM:A3组低于A0组(P<0.01),与B3、C组无异常,B3组低于BO组(P<0.01),与组无异。3、治疗6个月,总T细胞：A6组(23例)与A3、B6和C组无异,B3组(9例)变化不明显；CD8+：A6组与A3、B6、C组无异,B6组与B3、C组无异；CD4+：A6组与A3、B6、C组无异,B6组与B3、C组无异；CD4+／CD8+:A6组与A3、B6组无异,低于C组(P<0.01),B6组与B3组无异,仍低于C组(P<0.05)；NK细胞：A6组与A3、B6和C组无异,B6与B3、C组无异；总B细胞：A6组低于C组(P<0.05),与B3、C组无异,B6与B3、C组无异；IgA:A6组与A3、B6和C组无异,B6组与B3、C组无异；IgG:A6组与A3、B6组无异,低于C组(P<0.05),B6组与B3、C组无异；IgM:A6组与A3、B6和C组无异,B6组与B3、C组无异。4、感染次数,A组共发生上呼吸道感染6人次,肺炎2人次,占12.90%,肾病复发4人次,占6.45%。B组发生上呼吸道感染8人次,肺炎3人次,泌尿系感染2人次,占33.33%,肾病复发6人次,占15.38%。5、副作用：一名患儿服槐杞黄颗粒后出现较严重腹泻(排除感染性腹泻)。结论肾病综合征患儿治疗前细胞、体液免疫功能降低、紊乱；槐杞黄颗粒辅助治疗PNS过程中,提高NK杀伤细胞和T辅助淋巴细胞活性,减少感染并具有减少肾病复发的趋势。槐杞黄颗粒副作用轻微,可作为PNS治疗的辅助药物。更多还原

【Abstract】 ObjectiveTo observe the effect of Huaiqiuang paiticles on lymphocyte subpopulation, immunoglobulins and the infection of children with primary nephritic syndrome.MethodTotally 101 patients(60 males and 41 females,1-14 years old) first diagnosed with PNS were randomly divided into group A (62 cases) and group B (39 cases). Group A was treated with prednisone and Huaiqihuang particles, while Group B was treated with prednisone only. Observe the level of lymphocyte subpopulation and immunoglobulins before the treatment(A0,B0),3months(A3,B3) and 6months(A6,B6) after treatment. Record the infection and relapse patients within 6 months. Group C was control group (22 healthy children,13 males and 9 females).Result1 The CD8+T lymphocytes in group AO and BO were significantly higher than that of group C(P<0.05),while the CD4+T lymphocytes were significantly fewer (P<0.05),the proportion of CD4+to CD8+was significantly decreased, even inversion (P＜0.05).The level of NK cells in group AO and BO were significantly fewer than that of group C (P＜0.01). The IgA and IgG in group AO and BO were significantly fewer than that of group C (P<0.05, P<0.01). 2 3 month after treatment, the total T cells in group A3 was significantly higher than that of group A0,B3 and group C (P<0.05); the CD8+T cells in groupA3, AO and B3 were higher than group C(P<0.05), but there were no difference among groupA3, AO and B3; there were no difference of the CD8+T cells between group B3 and B0, which were both higher than that of group C(P<0.01); the CD4+T cells in groupA3, AO and group C were higher than that of group B3(P<0.01), but there were no difference among groupA3, AO and C; there were no difference of the CD4+T cells between group B3 and B0, which were both lower than that of group C(P<0.01);the CD4+/CD8+of group A3 and AO were higher than that of group B3(P<0.05),but lower than that of group C(P<0.05), there were no difference between group A3 and A0; the CD4+/CD8+of group B3 and BO were lower than that of group C(P<0.01), there were no difference between group B3 and B0(P<0.05); NK cells in group A3 was higher than that of group AO(P＜0.01) and group B3(P<0.05),but had no difference with groupC; NK cells in group B3 was higher than that of group B0(P<0.01),but had no difference with groupC; total B cells in group A3 was lower than that of group A0,B3 and C(P<0.01), total B cells in group B3 was lower than that of group B0, but had no difference with groupC; IgA in group A3, AO and B3 were lower than that of group C(P<0.05),but there were no difference among group A3, AO and B3; IgA in group B3 and BO were lower than that of group C, but there was no difference between these two groups; IgG in group A3 was higher than that of group A0(P<0.01),lower than that of group C(P<0.01),but there was no difference with group B3; IgG in group B3 were higher than that of group B0(P<0.01), but still lower than groupC(P＜0.01); IgM in group A3 was lower than that of group A0(P<0.01), but there were no difference with group B3 and C; IgM in group B3 were lower than that of group BO(P＜0.01);3 6month after treatment, there were no differences of the total T cells among the group A6, A3, B6 and C; there were no differences of CD8+T cells and CD4+T cells among the group A6, A3, B6 and C; there were no differences of CD8+T cells and CD4+T cells among the group B6, B3 and C; the CD4+/CD8+in group A6 A3 and B6 were lower than that of group C(P<0.01), there were no differences among group A6 A3 and B6; the CD4+/CD8+in group B6 and B3 were lower than that of group C(P<0.01), there were no differences between group B6 and B3; there were no differences of NK cells among group A6, A3,B6 and C, there were no differences of NK cells among group in group B6,B3 and C; total B cells in group A6 was lower than that of group C(P<0.05), there were no differences between group B3 and C, there were no differences of total B cells among group B6,B3 and groupC; there were no difference of IgA among group A6,A3,B3 and group C, there were no difference of IgA among group B6,B3 and group C; IgG in group A6,A3 and B6 were lower than that of group C(P<0.05), there were no differences among group B6,B3 and groupC; there were no difference of IgM among group A6,A3,B3 and group C, there were no difference of IgM among group B6,B3 and group C;4 The infection times of group A (12.9%,upper respiratory tract infection 6 times, pneumonia 2 times) were significantly fewer than group B (33.33%, upper respiratory tract infection 8 times, pneumonia 3 times, urinary tract infection 2times), and the relapse cases of group A (4,6.45%) were fewer than group B (6,15.38%).5 Side effect of Huaiqiuang particles, severe diarrhea(lcase).ConclusionThe cell immunity and the body fluid immunity is decreased and disturbed before theapy; the Huaiqihuang particles can improve the ability of NK cells and T help cells, decrease the infection and relapse of nephrotic syndrome; at the same time, Huaiqihuang particles has milt side effects.更多还原