紫仙丹方防治小儿过敏性紫癜肾损害的临床疗效观察

发布时间：2018-08-22 09:18

【摘要】：目的:观察紫仙丹方治疗小儿过敏性紫癜(血热妄行证)的临床疗效及治疗后尿微量白蛋白、β2-微球蛋白等指标的变化情况,分析其能否起到预防或减轻过敏性紫癜肾损害的作用。方法:选择符合纳入标准的过敏性紫癜患儿60例,按随机原则分为观察组30例、对照组30例。两组同时予基础治疗。对照组患儿予复方芦丁40mg/次口服,一天三次;双嘧达莫3-5mg/(kg-1·d-1),分2-3次口服。观察组在对照组基础上予紫仙丹方水煎剂,早晚两次分服。以4周为一个疗程,治疗3个疗程。观察记录两组治疗前及治疗4周、治疗8周、治疗12周后的临床症状、实验室观察指标等改善情况,对比分析两组治疗后的临床疗效及肾损害情况。在治疗结束后进行3个月的随访,比较两组复发率,分析两种治疗远期疗效。结果:(1)两组在治疗12周后,临床症状改善,中医证候总积分均较前降低(p0.05);观察组证候总积分减少较明显,与对照组相比,其差异具有统计学意义(p0.05)。(2)两组在治疗8周末、12周末m-Alb水平较同组治疗前产生了差异(p0.05),两组间差异明显(p0.01),观察组改善情况优于对照组;而两组第4周末时指标水平与同组治疗前无统计学差异(p0.05),两组间相比亦无差异(p0.05)。(3)观察组治疗4周末、8周末、12周末β2-GM水平较前无明显波动,差异无统计学意义(p0.05);对照组治疗4周末、8周末、12周末β2-GM水平较治疗前明显上升,差异均有统计学意义(p0.05);不同治疗时点两组差异具有高度统计学意义(p0.01),观察组优于对照组。(4)两组在治疗4周末、8周末、12周末时出现的肾损害例数差异具有统计学意义(p0.05),且观察组肾损例数明显少于对照组。(5)随访3月结束后,观察组总复发率低于对照组(p0.05)。结论:(1)中药紫仙丹方能有效缓解HSP患儿临床症状,在消退皮肤紫癜,缓解腹痛、关节痛,改善心烦口渴等情况具有明显优势,与对照组相比其疗效更确切。(2)紫仙丹方可以有效改善尿微量白蛋白、尿β2-微球蛋白等指标,与对照组相比,降低了肾损害发生率,一定程度上起到了预防或减轻肾损害的作用。(3)在随访中,观察组复发率显著低于对照组,故观察组治疗的远期效果更理想。(4)口服中药紫仙丹方治疗HSP效果显著,无明显毒副作用,药物安全可靠,值得临床应用推广。
[Abstract]:Objective: to observe the clinical effect of Zixiandan recipe in the treatment of allergic purpura in children and the changes of urinary microalbumin and 尾 2-microglobulin after treatment. To analyze whether it can prevent or alleviate the renal damage of Henoch-Schonlein purpura. Methods: 60 children with Henoch-Schonlein purpura were randomly divided into observation group (n = 30) and control group (n = 30). Both groups were treated with basic therapy at the same time. Children in the control group were given compound rutin 40mg/ three times a day and dipyridamole 3-5mg/ (kg-1 d-1) 2-3 times a day. Observation group in the control group on the basis of purple elixir decoction, morning and evening two times. 4 weeks as a course of treatment, 3 courses of treatment. To observe and record the improvement of clinical symptoms, laboratory observation indexes and so on before and after treatment for 4 weeks, 8 weeks and 12 weeks in the two groups, and to compare and analyze the clinical effect and renal damage after treatment in the two groups. Follow up for 3 months after the end of treatment, compare the recurrence rate of the two groups, and analyze the long-term curative effect of the two kinds of treatment. Results: (1) after 12 weeks of treatment, the clinical symptoms of the two groups were improved, the total score of TCM syndromes were all decreased (p0.05), the total score of syndromes in the observation group was significantly decreased than that in the control group, and that in the observation group was significantly lower than that in the control group. The difference was statistically significant (p0.05). (2). The level of m-Alb in the two groups was significantly higher than that in the control group at the end of 8 weeks and 12 weeks after treatment (p0. 05), and the improvement of the observation group was better than that of the control group (p0. 01). However, there was no significant difference between the two groups at the end of the 4th week (p0.05) and between the two groups before treatment (p0.05). (3). There was no significant change in 尾 2-GM level between the two groups at the end of the 4th week and the 12th weekend of the treatment group, and there was no significant difference between the two groups at the end of the 4th week and the 12th weekend after treatment. There was no significant difference (p0. 05), the 尾 2-GM level in the control group was significantly higher than that before treatment at the end of 4 and 8 weeks and 12 weeks after treatment. The difference was statistically significant (p0.05), the difference between the two groups at different time points was highly statistically significant (p0.01), and the observation group was superior to the control group. (4) there were significant differences in the number of cases of renal damage in the two groups at the end of the 4th week and the 8th weekend and the 12th weekend after treatment. The number of renal lesions in the observation group was significantly less than that in the control group. (5) after 3 months of follow-up, the number of renal lesions in the observation group was significantly lower than that in the control group. The total recurrence rate in the observation group was lower than that in the control group (p 0.05). Conclusion: (1) Zixiandan prescription can effectively relieve the clinical symptoms of children with HSP, and has obvious advantages in relieving skin purpura, relieving abdominal pain, joint pain, and improving upset and thirst. Compared with the control group, the curative effect is more accurate. (2) the purple immortal prescription can effectively improve the urinary microalbumin, urine 尾 2-microglobulin and other indexes, compared with the control group, it can reduce the incidence of renal damage. (3) the recurrence rate of the observation group was significantly lower than that of the control group, so the long-term effect of the observation group was better. (4) the effect of the oral Chinese medicine Zixiandan recipe on HSP was significant. There are no obvious side effects and the drugs are safe and reliable, which is worthy of clinical application.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

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