黄芪地黄汤对小儿过敏性紫癜肾炎TH_1/TH_2的影响

Effect of HQDHT on TH_1/TH_2 in Children's Henoch-Schoenlein Purpura Nephritis

目的:观察黄芪地黄汤治疗小儿过敏性紫癜肾炎(HSPN)的临床疗效及其对免疫功能的影响,探讨临床疗效和免疫功能变化之间的关系。方法:收集HSPN患者80例。随机分成两组,西医组40例,中西医结合组40例(西医组用药基础上加用黄芪地黄汤),并建立正常儿童对照组30例。观察疗程3个月。测定治疗前后相关细胞因子(IL-2、IL-4、IL-6、IL-12、TNF-α)水平及血尿常规、肝肾功能、免疫球蛋白、24h尿蛋白定量等变化。结果:与正常儿童对照组比较,西医组和中西医结合组的IL-12水平均下降,IL-4、IL-6水平上升(P均<0.05),TNF-α水平明显上升(P<0.01),而IL-2水平无统计学意义(P>0.05)。3个月后,中西医结合组总缓解率87.5%,西医组疗效总缓解率60%,二者有显著差别(P<0.05);中西医结合组IL-12、IL-4、IL-6水平基本降至正常,TNF-α水平仅略高于正常对照组;西医组IL-12水平接近正常水平,IL-4、IL-6及TNF-α水平略有下降。结论:黄芪地黄汤结合西药常规治疗可更有效逆转TH2亢进状态,使病情得到改善和防止进展,其疗效机制与免疫功能调控相关。

Objective.To observe the curative effect and iidluence of immune function of HQDHT in Children＇s Henoch- Schoenlein Purpura Nephritis （HSPN）, and study the relation of curative effect and change of immune function. Methods. 80 cases with HSPN were divided evenly into two groups, group 1 （western medicine group） and group 2 （Combination of Chinese and Westernmedicine group, which is added with HQDHT）. Other 30 normal children as control group. The course of treatment is 3 months. The related cytokines （include IL- 2, IL - 4, IL- 6, IL- 12 and TNF -α）, blood and urine routines, liver and kidney function, immunoglobulin and the quantitation of 24- hour proteinuria were mensurated and compare before and after treatment. Results：Compared with the control group, the level of IL- 12 decreased; the levels of IL- 4 and IL- 6 increased（P〈 0.05） ; TNF -α level also rise obviously（P 〈 0.01 ） ; but IL - 2 had no significant change（P 〉 0.05） in group 1 and group 2. After 3 months treatment, the total alleviating rate of group 2 was 87.5 %, while that of the group 1 was 60%. There was significant difference between the two groups. The levels of IL- 12, IL- 4 and IL- 6 almost returned to normal, and the TNF- a level was slightly higher than that of the coritrol group in group 2. In group 1, IL- 12 level approached the normal, while IL- 4, IL- 6 and TNF-α level slightly decreased. Conclusion： Treatment of Chinese and Western medicine can effectively reverse the hyperfunction of TH2 and thus improve the condition and prevent the progression. The curative effect mechanism of HQDHT is relation to immunoregualtion immunity function regulation.