雷公藤总苷对肾病型紫癜性肾炎患儿糖皮质激素受体的影响及其临床意义

Clinical Significance and Influence on Glucocorticoid Receptor Resulted from Tripterygium Wilfordii Hook F for Children with Nephrotic Type of Henoch-Schonlein Purpura Nephritis

目的探讨雷公藤总苷治疗小儿肾病型紫癜性肾炎(HSPN)的机制。方法将肾病型HSPN患儿44例随机分为对照组和研究1、2组。用放射配体结合分析法测定糖皮质激素受体(GCR)数目,比较3组GCR数及复发次数。并设健康对照组57例。结果肾病型HSPN患儿初次入院治疗前GCR明显低于健康对照组。用糖皮质激素(GC)泼尼松治疗1周各组GCR数均较治疗前降低。治疗3周测GCR,对照组较1周时有升高,研究1和2组较对照组明显回升。随访3个月～5年,复发次数对照组明显高于研究1和2组。结论雷公藤总苷治疗肾病型HSPN明显有效。不仅可减少泼尼松剂量,还明显减少复发次数。其作用机制之一可能是抵抗GC对GCR的下降调节作用,从而增强GC治疗效应。

Objective To explore the mechanism of tripterygium wilfordii hook f（TWHF）for Henoch-Schonlein purpura nephritis（HSPN,nephrotic type）in children.Methods All the children with HSPN（nephrotic type）were divided into 3 groups casually.Method of radioactive pairs conjugating analysis was used to determine the numbers of glucocorticoid（GC）receptors（GCRs）.Results were statistically analysed respectively.Results GCRs tested in all the patients with HSPN（nephrotic type）before treatment were statistically lower than those in control group of normal children;GCRs in all the patients tested after 1 week treatment with GC were lower than before treatment.Three weeks later,GCRs in patients treated with TWHF increased much higher than them without TWHF.Following up the recurring times of all the patients 3 months to 5 years,they were much more in patients treated without TWHF treatment than in patients treated with it.Conclusions TWHF treatment on HSPN（nephrotic type）is obviously effective.It can not only decrease the dosage of GC,but decrease the recurring times.One of the mechanism may be TWHF can resist the down-regulation GC to GCR,and enhance the effect of GC.