益肾活血法干预小儿原发性肾病综合征对NGAL及L-FABP的影响

发布时间：2018-06-14 00:16

本文选题：儿童原发性肾病综合征 + 人中性粒细胞明胶酶相关性脂质运载蛋白　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过观察益肾活血法干预小儿原发性肾病综合征(Primary Nephritic Syndrome,PNS)对人中性粒细胞明胶酶相关性脂质运载蛋白(Neutrophil Ge 1 atinase Associated Lipocalin,NGAL)及人肝型脂肪酸结合蛋白(Liver-type Fatty Acid Binding Protein,L-FABP)的影响,进一步完善小儿PNS的发病机制及益肾活血中药肾康灵治疗的作用机理,达到提高临床疗效,减少药物不良反应的目的。方法:选取门诊和病房PNS(单纯型,频复发)患儿40例,采用随机数字表法将病例分为中西医结合治疗组(A组)20例和西药对照组(B组)20例,另外选取健康儿童20例作为健康对照组(C组)。B组采取单纯西药治疗,A组在B组治疗的基础上加用益肾活血中药肾康灵煎剂(组成:黄芪、生地黄、山茱萸、山药、茯苓、牡丹皮、三七、赤芍等)。运用酶联免疫吸附法(ELISA)检测各组治疗前和治疗后1、3个月的尿NGAL、尿L-FABP水平变化,应用SPSS20.0统计软件对数据进行统计学分析。结果:1.治疗前比较,A、B两组尿NGAL、尿L-FABP水平较C组明显升高(P均0.01),而A、B两组比较无显著差异(P均0.05);A、B两组血清胱抑素、血肌酐、尿α1微球蛋白、尿蛋白、血清白蛋白、胆固醇、甘油三酯水平比较无显著差异(P均0.05)。2.治疗1个月后,A、B两组尿NGAL、尿L-FABP、尿α1微球蛋白、尿蛋白水平均较治疗前明显降低(P均0.01),A组尿L-FABP、尿蛋白水平低于B组(P尿L-FABP0.05,P尿蛋白0.01),A组尿NGAL水平明显高于B组(P0.01),A、B两组尿α1微球蛋白水平无显著差异(P0.05);A组胆固醇、甘油三酯水平较治疗前降低(P胆固醇0.01,P甘油三酯0.05),B组胆固醇、甘油三酯水平较治疗前无显著差异(P均0.05),A组低于B组(P均0.05);A、B两组血清胱抑素、血肌酐水平较治疗前无显著差异(P均0.05),A、B两组比较无显著差异(P均0.05);A、B两组血清白蛋白较前明显升高(P 均0,01),A 组高于 B 组(P0.05)。3.治疗3个月后,与治疗前比较A、B两组尿NGAL、尿L-FABP、尿α1微球蛋白、尿蛋白、胆固醇、甘油三酯水平均明显降低(PB-甘油三酯0.05,余P0.01),A、B两组血清白蛋白水平明显升高(P均0.01),A、B两组血清胱抑素、血肌酐无显著差异(P均0.05);与治疗1个月后比较,A组尿NGAL水平明显降低(P0.01)、B组无显著差异(P0.05),A组尿L-FABP水平无显著差异(P0.05)、B组明显降低(P0.01),A、B两组血清胱抑素、血肌酐无显著差异(P均0.05),A、B两组尿α1微球蛋白、尿蛋白、胆固醇、甘油三酯水平均明显降低(PA-尿蛋白0.05,PB-胆固醇0.05,PB-甘油三酯0.05,余P0.01),A、B两组血清白蛋白明显升高(P均0.01);A组与B组比较尿NGAL、尿L-FABP、尿α1微球蛋白、血清胱抑素、血肌酐水平均无显著差异(P均0.05),A组尿蛋白、胆固醇、甘油三酯水平低于B组(P尿蛋白0.05,P胆固醇0.05,P甘油三酯0.01),A组血清白蛋白水平高于B组(P0.05)。结论:1.PNS患儿的尿NGAL、尿L-FABP水平明显升高,提示NGAL、L-FABP可能参与儿童PNS的发病机制。2.应用中药肾康灵治疗后尿L-FABP下降明显,治疗1个月后治疗组指标水平低于对照组,中药肾康灵可能对降低患儿尿NGAL水平有一定作用,中药结合西药治疗,可能有助于减轻肾小管-间质损伤的程度。3.中西医结合治疗在降低异常升高的尿蛋白、血脂,升高血白蛋白等方面疗效优于单纯西药组,提示益肾活血法能改善患儿脂质代谢紊乱和高凝状态,从而缓解患儿病情,提高临床疗效。4.NGAL、L-FABP较血清胱抑素、血肌酐优先反映肾小管的损伤,可作为早期肾小管-间质损伤的生物学标志,为PNS的临床治疗和预后判断提供客观指标。
[Abstract]:Objective: To observe the effect of Primary Nephritic Syndrome (PNS) on human neutrophil gelatinase related lipid carrier protein (Neutrophil Ge 1 atinase Associated Lipocalin, NGAL) and human hepatoid fatty acid combined egg white (Liver-type Fatty) by observing the kidney and activating blood and blood activating method. To further improve the pathogenesis of children's PNS and the mechanism of Yishen activating and blood activating medicine Shen Kang Ling treatment mechanism, to improve the clinical effect and reduce the adverse drug reaction. Methods: 40 cases of PNS (simple type, frequency recurrence) in the outpatient and ward were selected, and the cases were divided into 20 cases and Western medicine group (group A) with the combination of traditional Chinese and Western Medicine (Group) and Western medicine. In the control group (group B), 20 healthy children were selected as the healthy control group (group C) and group.B was treated with pure western medicine. Group A was treated with Yishen Huoxue Chinese medicine Shen Kang Ling Decoction (composed of Astragalus, rehmannia, cornel, yam, tuckahoe, peony, peony, 37, red peony) on the basis of B group treatment. The enzyme linked immunosorbent assay (ELISA) was used to detect each group. The changes of urine NGAL and urine L-FABP level before and after 1,3 months after treatment were statistically analyzed with SPSS20.0 software. Results: 1. before treatment, A, B two groups were urine NGAL, the level of urine L-FABP was significantly higher than that in the C group (P 0.01), while A, B two had no significant difference (all 0.05). There was no significant difference in protein, urine protein, serum albumin, cholesterol and triglyceride (P 0.05).2. treatment for 1 months, A, B two groups of urine NGAL, urine L-FABP, urinary alpha 1 microglobulin, urinary protein levels were significantly lower than before treatment (P 0.01), A group urine L-FABP, urine protein level was lower than the B group (P Uria L-FABP0.05, proteinuria 0.01) There was no significant difference in the level of urinary alpha 1 microglobulin in A and B two groups (P0.05). The level of cholesterol and triglyceride in group A was lower than before treatment (P cholesterol 0.01, P triglyceride 0.05), B group cholesterol and triglyceride level was no significant difference compared with before treatment (P 0.05), A group was lower than that of B group (0.05); two groups of serum cystatin and serum creatinine water There was no significant difference before treatment (P 0.05), A and B two groups (P 0.05), A, B two increased significantly (P 0,01), A group was higher than B group (P0.05).3. treatment 3 months later, compared with before treatment, two groups of urine, urinary alpha 1 microglobulin, urinary protein, cholesterol, triglyceride levels were significantly reduced. B- triglyceride 0.05, residual P0.01), A, B two serum albumin level increased significantly (P 0.01), A, B two serum cystatin, serum creatinine no significant difference (P 0.05). Compared with the 1 months after treatment, the A group urine NGAL level decreased significantly (P0.01), B group, there was no significant difference There was no significant difference in serum cystatin and serum creatinine in B two groups (P 0.05), A and B two groups of urinary alpha 1 microglobulin, urinary protein, cholesterol, triglyceride level decreased significantly (PA- urine protein 0.05, PB- cholesterol 0.05, PB- triglyceride 0.05, residual P0.01), A, B two (P all 0.01); A group compared urine, urine, and urinary alpha 1 microspheres The levels of protein, serum cystatin and serum creatinine were not significantly different (P 0.05). The level of urine protein, cholesterol and triglyceride in group A was lower than that in group B (P urine protein 0.05, P cholesterol 0.05, P triglyceride 0.01). The serum albumin level in A group was higher than that of group B (P0.05). Conclusion: the urine NGAL, urinary L-FABP level of 1.PNS children was significantly higher. The pathogenesis of PNS in children was significantly lower than that of the control group after treatment with Chinese medicine Shen Kang Ling. After 1 months of treatment, the index level of the treatment group was lower than that of the control group. The Chinese medicine Shen Kang Ling may have a certain effect on reducing the NGAL level in the urine of the children. The combination of traditional Chinese medicine and Western medicine may help to reduce the degree of renal tubulointerstitial injury by the combination of Chinese and Western medicine. It is better to reduce the abnormal increase of urine protein, blood lipid, increase blood albumin and other aspects than the simple western medicine group, suggesting that Yishen activating blood method can improve the disorder of lipid metabolism and hypercoagulability in children, thus relieving the disease of the children and improving the clinical efficacy of.4.NGAL, L-FABP is compared with serum cystatin, and the blood creatinine is a priority to reflect the injury of renal tubules, which can be used as an early stage. Biomarkers of tubulointerstitial injury provide objective indicators for the clinical treatment and prognosis of PNS.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

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