祛风滋阴法治疗儿童过敏性紫癜的临床研究

发布时间：2018-03-12 15:34

本文选题：儿童/小儿过敏性紫癜　切入点：祛风滋阴法　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究旨在通过观察西医基础治疗上加用以祛风滋阴为大法的中成药制剂(槐杞黄颗粒)治疗小儿过敏性紫癜(henoch-schonlein/allergic purpura,HSP或AP)与单纯西医基础治疗的疗效比较,以探讨祛风滋阴法对HSP的治疗作用及其可能的作用机制,并寻求一种安全有效的治疗HSP的中成药制剂,以提供一种优化治疗方案。方法符合纳入标准的HSP患儿200例均来自于大连市儿童医院中医科、皮肤科门诊、肾内科住院。随机分为2组,即观察组和对照组各占100例。西医基础治疗:维生素C、芦丁片、氯雷他定片常规口服;若有明显感染,给予敏感抗生素;酌情应用糖皮质激素。(肾上腺糖皮质激素规范:有中重度消化道出血或血管神经水肿者,应用地塞米松0.25-0.75mg/kg静点或口服强的松1-1.5mg/kg。)观察组:西药基础治疗同上。加服槐杞黄颗粒,每次1袋,Bid。对照组:予西医基础治疗。疗程:4周为1疗程,连续用药3个疗程,并随访1年。将两组临床疗效及主要症状消失时间、复发率、治疗结束时两组紫癜性肾炎发生情况进行比较对照。观察两组患儿治疗前后细胞免疫、血清及尿肝细胞生长因子(hepatocyte growth factor,HGF)水平变化。结果1.从临床疗效来看,观察组与对照组的总有效率分别为94.0%和73.0%,两组总有效率有显著统计学差异,P0.001,提示观察组的临疗疗效明显比对照组好。2.从两组主要症状消失时间上看,经检验,两组在紫癜消失时间与腹痛消失时间上比较,P均0.05,有显著性差别,结果提示观察组在紫癜消失时间与腹痛消失时间上较对照组好;关节疼痛消失时间比较,P0.05,两组不存在显著差别。3.从治疗结束时两组紫癜性肾炎发生情况看,观察组发生肾损害者的程度较对照组轻,紫癜性肾炎的发生例数较对照组少。4.两组治疗前后血清和尿HGF水平变化比较,2组治疗前基线水平对比差异无统计学意义。与本组治疗前比较,两组治疗后血清及尿HGF水平均较治疗前降低(P0.05),但观察组治疗前后血清及尿肝细胞生长因子水平的减少量显著高于对照组。5.治疗结束时两组患儿治疗前后外周血CD4+与CD8+水平变化比较,与本组治疗前比较,2组均有显著统计学差异(P0.05),但观察组CD4+,CD8+与CD4+/CD8+水平变量均显著高于对照组(P均0.01),提示观察组较对照组对细胞免疫的调整更为明显,P0.05。6.两组患儿复发率比较显示:观察组复发率4%,对照组复发率24%,P0.001,差异有统计学意义,说明观察组的复发率显著低于对照组。结论1.祛风滋阴法治疗儿童HSP临床综合疗效显著,可以显著缩短患儿紫癜与腹痛症状的消失时间,缩短病程。2.祛风滋阴法治疗儿童HSP,通过调整患儿的细胞免疫功能,提升了患儿抵抗和预防疾病的能力,明显降低了复发率,有效预防了HSPN的发生。3.治疗HSP过程中动态监测血清及尿HGF可能对判断病情起到重要作用,初步推测以祛风滋阴为大法的槐杞黄治疗HSP的可能机制是通过影响血清及尿HGF水平来发挥抗炎及修复损伤内皮细胞作用的。4.以祛风滋阴法为治疗原则,应用中成药制剂“槐杞黄颗粒”治疗儿童HSP安全且副作用甚微,携带保存方便,口感佳,患儿乐于接受,家长依从性高,可广泛推广于HSP的临床治疗中。
[Abstract]:The purpose of this study is to observe the basic treatment of Western medicine combined with traditional Chinese medicine for nourishing yin and Dafa wind (Huai Qi Huang Keli) in the treatment of Henoch Schonlein purpura (henoch-schonlein/allergic purpura, HSP or AP) compared with the efficacy of simple treatment, to explore the method of Nourishing Yin Qufeng therapy for HSP effect and possible mechanism of traditional Chinese medicine preparation and to seek a safe and effective treatment of HSP, in order to provide an optimal treatment. Methods met the inclusion criteria of 200 HSP patients were from the Department of traditional Chinese medicine, Dalian children's Hospital Outpatient Department of Dermatology, Department of Nephrology hospital were randomly divided into 2 groups: observation group and control group 100 cases. The basis of Western medicine treatment: vitamin C, Rutinum Tablets, Loratadine Tablets, conventional oral; if there was infection, giving antibiotics; appropriate glucocorticoids. (glucocorticoid specification: in weight The degree of gastrointestinal bleeding or vascular nerve edema, dexamethasone 0.25-0.75mg/kg intravenous or oral prednisone 1-1.5mg/kg.) observation group: Western medicine therapy ibid. With Huaiqihuang granules, 1 per bag, Bid. control group treated with western medicine treatment: 4 weeks of continuous medication for 1 courses, 3 courses, and follow up 1 years. The main symptoms and clinical efficacy of the two groups disappeared time, recurrence rate, end of treatment group two purpura nephritis incidence were compared. Two groups were observed before and after treatment of cellular immunity, serum and urine of hepatocyte growth factor (hepatocyte growth, factor, HGF) level. The results from 1. clinical. The observation group and the control group in the total efficiency were 94% and 73%, the total efficiency of two groups had significant difference, P0.001, prompt treatment on the curative effect of observation group was better than the control group.2. from the two main groups of symptoms disappeared time Look, after inspection, the two groups were compared with purpura disappearance time of abdominal pain disappeared time, P was 0.05, there was significant difference between the results in the observation group, purpura disappeared time and abdominal pain disappeared time than the control group; joint pain disappeared time, P0.05, the two groups are not significant difference between the two groups from.3. at the end of treatment of purpura nephritis occurrence situation, the observation group occurred in renal damage degree were lighter than the control group, the number of cases of purpura nephritis compared with control serum and urine levels of HGF group before and after.4. treatment in the two groups, the 2 groups before treatment on baseline than no significant differences compared with the group. Before treatment, the two groups after treatment of serum and urine HGF levels were lower than those before treatment (P0.05), but the observation group before and after treatment with growth factor levels in serum and urine of liver cells was significantly higher than the control group to reduce the amount of the end of the.5. treatment in two groups before and after treatment of peripheral blood Comparison of CD4+ and CD8+ level, compared with the group before treatment, the 2 groups were statistically significant differences (P0.05), but the observation group CD4+, CD8+ and CD4+/CD8+ level variables were significantly higher than control group (P < 0.01), suggesting that the observation group than in the control group on the cell immune adjustment is more obvious, P0.05.6. of two groups the recurrence rate comparison showed that the recurrence rate of the observation group was 4%, the recurrence rate of the control group 24%, P0.001, the difference was statistically significant, indicating the recurrence rate of the observation group was significantly lower than the control group. Conclusion the 1. wind nourishing Yin in treating children with HSP clinical comprehensive curative effect, can significantly shorten the disappearance time of children with purpura and abdominal pain symptoms, shorten the course of.2. Qufeng nourishing yin method in treating children with HSP, the cellular immune function to adjust the children, enhance the ability of children to resist and prevent disease, significantly reduces the recurrence rate, effectively prevent the occurrence of dynamic monitoring of blood.3. in treatment of HSP in the process of HSPN Clear and urinary HGF may play an important role in diagnosis, speculated that the wind Yin for Dafa Huaiqihuang treatment of HSP may play an anti-inflammatory mechanism is to repair the damage of endothelial cells and the effect of serum and urine levels of HGF.4. in Qufeng nourishing yin for the treatment of the principle, should use the traditional Chinese Medicine preparation "Huaiqihuang Granule" in the treatment of children HSP safe and side effect, convenient carrying and preservation, good taste, children are willing to accept high compliance of parents, can be widely used in the clinical treatment of HSP.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

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