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

发布时间：2018-04-12 19:05

本文选题：过敏性紫癜性肾炎 + 儿童　；参考：《辽宁中医药大学》2013年博士论文

【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。
[Abstract]:Objective : To observe the clinical efficacy and safety of Fu Shen Tang in the treatment of allergic purpura nephritis in children with damp heat and blood stasis , thus providing more effective therapeutic drugs for the clinical treatment of children allergic purpura nephritis .

Methods : All selected cases of this clinical observation were diagnosed as children with Henoch - Schonlein purpura nephritis ( hematuria and / or proteinuria ) . Sixty patients were randomly divided into two groups : traditional Chinese medicine treatment group ( hereinafter referred to as the treatment group ) and the control group ( hereinafter referred to as control group ) .
At the same time , the treatment group was taken orally with a tutor ' s experience in the treatment of basic therapy . The two groups were treated with one month as one treatment course and three treatment courses were observed . After the treatment was completed , the clinical curative effect was observed , and all the cases which were not shed were followed up for 3 months , and the clinical results were summarized .

Results :

1 . There was no significant difference in general data , clinical symptoms , signs , traditional Chinese medicine syndrome score , urine red blood cell count , 24 hour protein amount and other physical and chemical examination indexes before treatment in both groups , and the statistical analysis ( P > 0.05 ) showed comparability .

2 . Compared with the control group , the clinical total effective rate was 64.3 % , the total effective rate was 92.9 % , the rate of clinical total effective rate was 33.3 % , the clinical total effective rate was 70.4 % .

3 . Compared with the control group , there was significant difference between treatment group and control group ( P & lt ; 0.05 ) , and the score of TCM syndrome differentiation was significantly lower than that in control group ( P & lt ; 0.05 ) .

Compared with the control group , the clinical total effective rate was 85.7 % , the clinical total effective rate was 100.0 % , the rate of clinical total effective rate was 51.9 % , the clinical total effective rate was 81.5 % .

4 . Compared with the control group , there was a significant difference between treatment group and control group before and after treatment ( P < 0 . 05 ) . Compared with the control group , there was a significant difference between treatment group and control group ( P < 0.05 ) .

Compared with the control group , the 24 - hour urinary protein in the treatment group was significantly lower than that in the control group ( P > 0.05 ) , but there was no significant difference in 24 - hour urinary protein ration between the treatment group and the control group ( P > 0.05 ) .

In this clinical observation , the treatment group was obviously superior to the control group in the aspects of decreasing urinary 尾 2 - microglobin , urinary microalbumin , regulating immunoglobulin IgA , IgG and lowering platelet count , improving blood coagulation function , etc . , and statistical analysis showed significant difference ( P < 0.05 ) .

5 . The results showed that the follow - up recurrence rate was 5.6 % in the treatment group and 33.3 % in the control group ( P < 0.05 ) .
The number of adverse reactions in the treatment group was significantly lower than that of the control group during the two groups of treatment ( P < 0.05 ) .

Conclusion :

1 . The clinical manifestation hematuria and / or proteinuria - based infantile allergic purpura nephritis is treated with traditional Chinese medicine complex kidney soup by the Chinese traditional Chinese medicine syndrome differentiation , and has the function of better reducing the urine red blood cell and the urinary protein .

2 . Fu Shen Tang can obviously improve the TCM clinical symptoms of damp - heat - stasis - type allergic purpura nephritis , and has no obvious side effect , but the effect of complex kidney decoction on reducing urinary protein is not obvious than that of tripterygium glycosides tablet .

3 . By observing the effects of complex kidney decoction on IgA , IgG , IgM and platelet and blood coagulation function before and after treatment of Henoch - Schonlein purpura nephritis , the mechanism of action of this disease may be related to the factors such as inflammation , immune function , blood hypercoagulability , etc . , but the specific mechanism and the existence of other mechanism of action are to be further studied in the future .

【学位授予单位】：辽宁中医药大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R272

【参考文献】