槐杞黄颗粒对过敏性紫癜性肾炎的疗效观察
发布时间：2019-04-15 20:07
【摘要】：目的：过敏性紫癜性肾炎（HSPN）是我国儿童时期常见的继发性肾小球疾病之一，且其发病率有逐年增加的趋势。其发病机制主要涉及到免疫系统紊乱，同时有细胞因子与炎症介质的参与，凝血与纤溶紊乱以及基因多态性改变也发挥着重要作用。本研究观察具有免疫调节作用、滋肾润肺补肝等功能的槐杞黄颗粒对HSPN患儿的血清T细胞亚群（CD3+、CD4+、CD8+以及CD4/CD8+）、尿肾损伤分子-1（Kim-1）及尿P选择素的影响，从而了解槐杞黄颗粒是否对过敏性紫癜性肾患儿的免疫功能、细胞因子及凝血系统等方面均有调节作用。 方法： 1研究对象及实验分组：选择2010年11月至2011年10月在我院小儿肾脏内科住院的符合目前国内制定的HSPN诊断标准(2000年,珠海)的患儿54例，其中男35例，女19例，年龄3-14岁，根据HSPN的临床表现分为：A组即少量蛋白尿和（或）血尿组，B组即大量蛋白尿组（大量蛋白尿即24小时尿蛋白定量≥50mg/kg）。将A组、B组按照随机原则分别分A1（16例，男10例，女6例，平均年龄7.6岁）、B1（10例，，男7例，女3例，平均年龄8岁）为治疗组，A2（18例，男11例，女7例，平均年龄7.4岁）、B2（10例，男7例，女3例，平均年龄7.9岁）为对照组。均为初治患儿，入院前未应用激素及其它免疫抑制剂，除外入院前两周曾用过肾毒性药物者及各种原因引起的急慢性肾功能损害患儿。入院后A、B两组均给予常规治疗（包括泼尼松、维生素C、芦丁、强溢、迪巧、肾炎康复片、抗感染等），在此基础上，治疗组加用槐杞黄颗粒，小于3岁，5g bid；大于3岁，10g bid；疗程1个月。另设健康组15例，其中男7例，女8例，平均年龄6.8岁。选择同期门诊年龄、性别相匹配的健康体检儿童，无风湿、哮喘病史。 2检测指标及实验方法：采用流式细胞术测定T淋巴细胞亚群，用双抗体夹心ABC-ELISA法测尿P选择素和尿肾损伤分子-1的表达。各种指标分别于入院后常规用药治疗前和用药一个月之后检测。所得数据采用SPSS13.0统计分析软件进行统计学处理，采用均数±标准差表示，临床资料各组间统计学方法为t检验和方差分析，以P0.05代表有显著差异，P0.05为无显著差异。 结果： 1A组、B组及健康组T细胞亚群测定值的比较 1.1A1、A2两组患儿治疗前CD3+、CD4+、CD8+与CD4/8+比较，差异无统计学意义(P0.05)。A1、A2两组治疗前与健康组比较，CD3+、CD4+差异均有统计学意义(P0.05)。两组治疗前后CD4+比较，差异有统计学意义(P0.05);两组治疗后比较,改善CD4+方面,治疗组优于对照组(P0.05)。A1组治疗后与健康组比较，CD3+、CD4+、CD8+与CD4/8+差异均无统计学意义(P0.05)，而A2组治疗后与健康组比较，CD3+、CD4+差异仍有统计学意义(P0.05)。可见治疗组在改善血清CD3+、CD4+方面优于对照组。 1.2B1、B2两组患儿治疗前CD3+、CD4+、CD8+与CD4/8+比较，差异无统计学意义(P0.05)。B1、B2两组治疗前与健康组比较，CD3+、CD4+、CD8+与CD4/8+差异均有统计学意义(P0.05)。两组治疗前后CD3+、CD8+比较，差异有统计学意义(P0.05)；两组治疗后比较,改善CD3+、CD8+方面，治疗组优于对照组(P0.05)。2A组、B组患儿尿肾损伤分子-1（Kim-1）测定值的比较 2.1A1、A2两组患儿治疗前尿Kim-1数值无统计学意义(P0.05)。这两组患儿治疗后与治疗前相比，尿Kim-1数值均明显降低，差异有统计学意义(P0.05)；这两组患儿治疗后尿Kim-1数值相比，A1组在降低尿Kim-1方面,优于A2组(P0.05)。 2.2B1、B2两组患儿治疗前尿Kim-1数值无统计学意义(P0.05)。这两组患儿治疗后与治疗前比较，尿Kim-1数值均明显降低，差异有统计学意义(P0.05)；这两组患儿治疗后尿Kim-1测定值相比较，在保护肾脏方面，B1组优于B2组(P0.05)。 3A组、B组患儿尿P选择素测定值的比较 3.1A1、A2两组患儿治疗前尿P选择素数值无统计学意义(P0.05)。这两组患儿治疗后与治疗前相比，尿P选择素数值均下降，差异有统计学意义(P0.05)；这两组患儿治疗后尿P选择素测定值相比较，无统计学意义(P0.05)。 3.2B1、B2两组患儿治疗前尿P选择素数值无统计学意义(P0.05)。这两组患儿治疗后与治疗前比较，尿P选择素数值均降低，差异有统计学意义(P0.05)；这两组患儿治疗后尿P选择素测定值相比较，在活血方面，两组无明显差异(P0.05)。 结论：过敏性紫癜性肾炎患儿治疗前存在T细胞免疫功能降低、紊乱，凝血与纤溶紊乱及肾脏损害。槐杞黄颗粒不但能明显改善T细胞免疫功能紊乱，还具有保护肾脏的作用，但对于改善凝血与纤溶紊乱作用不明显。槐杞黄颗粒副作用甚微，可作为HSPN治疗的辅助药物。
[Abstract]:Objective: Henoch-Schonlein purpura nephritis (HSPN) is one of the most common secondary glomerular diseases in childhood, and its incidence is increasing year by year. The pathogenesis of the invention is mainly related to the disorder of the immune system, and also plays an important role in the participation of the cytokines and the inflammatory mediators, the coagulation and the fibrinolysis and the change of the gene polymorphism. The effects of the anti-immune function, the nourishing of the kidney and the liver and the like on the serum T cell subpopulation (CD3 +, CD4 +, CD8 + and CD4/ CD8 +), the molecule-1 (Kim-1) and the urine P-selectin in children with HSPN were observed in this study. So as to know whether the pagodatree granules have a regulating effect on the immune function, the cytokine and the blood coagulation system of the allergic purpura renal children. square Method:1 study object and experimental group:54 cases of children with renal internal medicine in our hospital from November 2010 to October 2011 were selected according to the current standard of HSPN diagnosis (2000, Zhuhai). Among them,35 were male,19 were female, and 3-3 in age. The clinical manifestations of HSPN were divided into two groups: A group, a small amount of proteinuria and/ or a hematuria group, and a large number of proteinuria groups in group B (a large amount of proteinuria,24-hour urine protein, and 50 mg/ kg), according to the clinical manifestations of HSPN. Kg). group A and group B were divided into A1 (16 cases, male 10 cases, female 6 cases, mean age 7.6 years), B1 (10 cases, male 7 cases, female 3 cases, average age 8 years) as treatment group, A2 (18 cases, male 11 cases, female 7 cases, average age 7.4years), B2 (10 cases, male 7 cases) according to the random principle. 3 cases (mean age: 7.9 years) were women. The control group received no hormone and other immunosuppressants before the admission, except for the acute and chronic renal failure caused by the renal toxicity drug and various causes in the first two weeks of the admission. The two groups after admission were treated with routine treatment (including prednisone, vitamin C, rutin, strong overflow, diaoqiao, nephritis rehabilitation, anti-infection, etc.). In one month, there were 15 healthy groups, including 7 males and 8 females, with an average age of 6 .8-year-old. Choose a healthy child with the same age and gender in the same period of the same period. History of asthma. detection index and experimental method: using flow cytometry to measure T lymphocyte subpopulation, and using double antibody sandwich ABC-ELISA to measure urine P-selectin and urine-kidney injury molecule. -1. The various indices were before and after the routine treatment before admission. After the month, the data was measured by SPSS 13.0. The statistical method of the clinical data was t-test and variance analysis, and the difference between the two groups was P0.05. No significant Difference. Results: Group 1A, group B, and healthy group T The difference of CD3 +, CD4 +, CD8 + and CD4/8 + in the two groups was not significant (P0.05). Compared with the healthy group, the CD3 + and CD4 + differences were both in series. The difference of CD4 +, CD4 +, CD8 + and CD4/8 + in the treatment group was higher than that in the control group (P0.05). The difference of CD3 + and CD4 + in the treatment of A2 group compared with that in the healthy group, and the difference between CD3 + and CD4 + was still in series. In the treatment group, the serum CD3 + was improved. The difference of CD3 +, CD4 +, CD8 + and CD4/8 + in the two groups was significantly higher than that in the control group. The difference of CD3 + and CD8 + in the two groups was statistically significant (P0.05), and the treatment group was better than that of the control group (P0.05). 1(Kim- 1) Comparison of the measured values 2.1 A1 and A2 two groups of children in the treatment of urine Kim-1 There was no significant difference in the number of urinary Kim-1 in the two groups (P0.05). On the other hand, it was superior to that of the A2 group (P0.05). -1. There was no significant difference between the two groups (P0.05). The surface and B1 group were superior to the B2 group (P0.05). Comparison of the measurement of urinary P-selectin in group 3A and group B, and the treatment of the two groups in group A and A2 There was no significant difference in the value of P-selectin in the two groups (P0.05). The values of the two groups were not significant (P0.05). There was no significant difference in the value of the P-selectin in the two groups (P0.05). The values of the P-selectin in the two groups were lower and the difference was significant (P <0.05). The value of the P-selectin in the two groups was measured. In comparison, there was no significant difference between the two groups in the aspect of blood circulation (P0.05). Conclusion: The pre-treatment of the children with Henoch-Schonlein purpura nephritis The immune function of T cell is reduced, the disorder, the coagulation and the fibrinolysis, and the kidney damage. The pagodatree granule not only can obviously improve the immune function of the T cell, but also has the function of improving the immune function of the T cell, The effect of the kidney is protected, but the effect of improving the coagulation and the fibrinolysis is not obvious.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272
本文编号：2458453
[Abstract]:Objective: Henoch-Schonlein purpura nephritis (HSPN) is one of the most common secondary glomerular diseases in childhood, and its incidence is increasing year by year. The pathogenesis of the invention is mainly related to the disorder of the immune system, and also plays an important role in the participation of the cytokines and the inflammatory mediators, the coagulation and the fibrinolysis and the change of the gene polymorphism. The effects of the anti-immune function, the nourishing of the kidney and the liver and the like on the serum T cell subpopulation (CD3 +, CD4 +, CD8 + and CD4/ CD8 +), the molecule-1 (Kim-1) and the urine P-selectin in children with HSPN were observed in this study. So as to know whether the pagodatree granules have a regulating effect on the immune function, the cytokine and the blood coagulation system of the allergic purpura renal children. square Method:1 study object and experimental group:54 cases of children with renal internal medicine in our hospital from November 2010 to October 2011 were selected according to the current standard of HSPN diagnosis (2000, Zhuhai). Among them,35 were male,19 were female, and 3-3 in age. The clinical manifestations of HSPN were divided into two groups: A group, a small amount of proteinuria and/ or a hematuria group, and a large number of proteinuria groups in group B (a large amount of proteinuria,24-hour urine protein, and 50 mg/ kg), according to the clinical manifestations of HSPN. Kg). group A and group B were divided into A1 (16 cases, male 10 cases, female 6 cases, mean age 7.6 years), B1 (10 cases, male 7 cases, female 3 cases, average age 8 years) as treatment group, A2 (18 cases, male 11 cases, female 7 cases, average age 7.4years), B2 (10 cases, male 7 cases) according to the random principle. 3 cases (mean age: 7.9 years) were women. The control group received no hormone and other immunosuppressants before the admission, except for the acute and chronic renal failure caused by the renal toxicity drug and various causes in the first two weeks of the admission. The two groups after admission were treated with routine treatment (including prednisone, vitamin C, rutin, strong overflow, diaoqiao, nephritis rehabilitation, anti-infection, etc.). In one month, there were 15 healthy groups, including 7 males and 8 females, with an average age of 6 .8-year-old. Choose a healthy child with the same age and gender in the same period of the same period. History of asthma. detection index and experimental method: using flow cytometry to measure T lymphocyte subpopulation, and using double antibody sandwich ABC-ELISA to measure urine P-selectin and urine-kidney injury molecule. -1. The various indices were before and after the routine treatment before admission. After the month, the data was measured by SPSS 13.0. The statistical method of the clinical data was t-test and variance analysis, and the difference between the two groups was P0.05. No significant Difference. Results: Group 1A, group B, and healthy group T The difference of CD3 +, CD4 +, CD8 + and CD4/8 + in the two groups was not significant (P0.05). Compared with the healthy group, the CD3 + and CD4 + differences were both in series. The difference of CD4 +, CD4 +, CD8 + and CD4/8 + in the treatment group was higher than that in the control group (P0.05). The difference of CD3 + and CD4 + in the treatment of A2 group compared with that in the healthy group, and the difference between CD3 + and CD4 + was still in series. In the treatment group, the serum CD3 + was improved. The difference of CD3 +, CD4 +, CD8 + and CD4/8 + in the two groups was significantly higher than that in the control group. The difference of CD3 + and CD8 + in the two groups was statistically significant (P0.05), and the treatment group was better than that of the control group (P0.05). 1(Kim- 1) Comparison of the measured values 2.1 A1 and A2 two groups of children in the treatment of urine Kim-1 There was no significant difference in the number of urinary Kim-1 in the two groups (P0.05). On the other hand, it was superior to that of the A2 group (P0.05). -1. There was no significant difference between the two groups (P0.05). The surface and B1 group were superior to the B2 group (P0.05). Comparison of the measurement of urinary P-selectin in group 3A and group B, and the treatment of the two groups in group A and A2 There was no significant difference in the value of P-selectin in the two groups (P0.05). The values of the two groups were not significant (P0.05). There was no significant difference in the value of the P-selectin in the two groups (P0.05). The values of the P-selectin in the two groups were lower and the difference was significant (P <0.05). The value of the P-selectin in the two groups was measured. In comparison, there was no significant difference between the two groups in the aspect of blood circulation (P0.05). Conclusion: The pre-treatment of the children with Henoch-Schonlein purpura nephritis The immune function of T cell is reduced, the disorder, the coagulation and the fibrinolysis, and the kidney damage. The pagodatree granule not only can obviously improve the immune function of the T cell, but also has the function of improving the immune function of the T cell, The effect of the kidney is protected, but the effect of improving the coagulation and the fibrinolysis is not obvious.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R272
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