芪苓通络方加减联合糖皮质激素对肾病综合征患儿肾脏微循环和Th1/Th2平衡的影响

Effect of Modified Qiling Tongluo Decoction Combined with Glucocorticoid on Renal Microcirculation and Th1/Th2Balance for Children with Nephrotic Syndrome

目的:观察芪苓通络方加减联合糖皮质激素治疗肾病综合征患儿对其肾脏微循环及辅助性T淋巴细胞1型(Th1)/辅助性T淋巴细胞2型(Th2)平衡的影响。方法:选择我院2019年1月~2020年1月收治的96例肾病综合征患儿,用抛硬币法随机分为观察组与对照组各48例,对照组应用糖皮质激素治疗,观察组运用芪苓通络方加减联合糖皮质激素治疗,观察治疗2个月后两组疗效,对比两组患儿治疗前后中医证候积分、肾脏微循环情况、免疫平衡状态指标。结果:治疗2个月后,观察组与对照组治疗有效率分别为93.75%、81.25%,观察组疗效等级优于对照组(P<0.05)。两组患儿浮肿、纳呆等中医证候积分均降低(P<0.05),且观察组低于对照组(P<0.05)。两组患儿肾脏皮质灌注时间-强度曲线量化参数峰值强度(PI)均上升,达峰时间(TP)、峰值强度减半时间(HPT)均降低(P<0.05),观察组参数改善优于对照组(P<0.05)。两组患儿血清白介素2(IL-2)、干扰素γ(IFN-γ)等Th1指标水平上升,白介素4(IL-4)、白介素10(IL-10)等Th2指标水平降低(P<0.05),且观察组患儿免疫指标改善幅度优于对照组,Th1/Th2比值高于对照组(P<0.05)。结论:芪苓通络方加减联合糖皮质激素治疗肾病患儿疗效确切,可有效改善肾脏微循环情况,调节机体Th1/Th2平衡状态。

Objective:To observe the effect of Modified Qiling Tongluo Decoction combined with glucocorticoid on the renal microcirculation and T helper type 1 lymphocyte(Th1)/T helper type 2 lymphocyte(Th2)balance for children with nephrotic syndrome.Methods:96 children with nephrotic syndrome treated in the hospital were selected between January 2019 and January 2020,and were randomly divided into an observation group and a controlled group by coin tossing method,with 48 cases in each group.The controlled group was treated with glucocorticoid,and the observation group was given Modified Qiling Tongluo Decoction combined with glucocorticoid therapy.The efficacy of the two groups was observed after 2 months of treatment,and the scores of TCM syndromes,renal microcirculation and immune balance status indicators were compared between the two groups before and after treatment.Results:After 2 months of treatment,the effective rates of treatment in the observation group and the controlled group were 93.75%and 81.25%respectively,and the efficacy grading of the observation group was better than that of the controlled group(P<0.05).The scores of TCM syndromes such as edema and anorexia were reduced in the two groups of children(P<0.05),and the scores were lower in the observation group than those in the controlled group(P<0.05).From the aspects of quantitative parameters of renal cortical perfusion time-intensity curve,the peak intensity(PI)of the two groups was increased,while the time to peak(TP)and half-time of peak intensity(HPT)were shortened(P<0.05),and the improvement of each parameter in the observation group was better than that in the controlled group(P<0.05).The levels of Th1 indicators such as serum interleukin 2(IL-2)and interferon γ(IFN-γ)in the two groups were enhanced while the levels of Th2 indicators such as interleukin 4(IL-4)and interleukin 10(IL-10)were reduced(P<0.05),and the improvement degrees of immune indicators in the observation group were better than those in the controlled group,and the Th1/Th2 ratio was higher than that in the controlled group(P<0.05).Conclusion:Modified Qiling Tongluo Decoction combined with glucocorticoid has a definite efficacy in the treatment of children with nephropathy,and it can effectively improve the renal microcirculation and regulate the body’s Th1/Th2 balance.