紫癜肾Ⅰ号方治疗过敏性紫癜肾炎45例

Zidianshen Ⅰ Number Decoction on Henoch-schonlein Purpura Nephritis with 45 Cases

目的:探讨紫癜肾Ⅰ号方治疗过敏性紫癜肾炎(HSPN)的疗效及对凝血机制和血液流变学的影响。方法:将90例HSPN患儿随机按诊治前后分为对照组和观察组各45例。两组给予西医常规治疗,均根据不同的临床表现采用双嘧达莫、雷公藤多苷片和强的松进行治疗。观察组在对照组治疗的基础上加服紫癜肾I号方,1剂/d。两组疗程均为12周。监测血尿、蛋白尿,进行治疗前后24 h尿蛋白定量、血液流变学、纤维蛋白原(FIB)、D-二聚体(D-D)及纤维蛋白降解产物(FDP)检测。结果:观察组疾病疗效总有效率为95.6%优于对照组的80%(P<0.05);治疗后观察组尿红细胞和24 h尿白蛋白水平均低于对照组(P<0.01);治疗后观察组尿红细胞阴转率为88.2%,尿白蛋白阴转率为82.9%,分别高于对照组的61.7%和54.1%(P<0.05);治疗后观察组FIB,FDP及D-D水平低于对照组(P<0.01);治疗后观察组血液流变学指标全血黏度(低切、高切)、全血还原黏度(低切、高切)、血小板聚集率及血浆黏度的改善均优于对照组(P<0.01)。结论:在西医常规治疗的基础上,紫癜肾I号方能降低HSPN患儿尿红细胞和尿白细胞,促进尿红细胞和尿白细胞阴转,其作用机制可能与改善凝血机制和血液流变学指标,降低高凝状态有关。

Objective： Discuss curative effect of purpuric nephropathy Zidianshen Ⅰ number decoction on henoch-schonlein purpura nephritis （HSPN） and influence to clotting mechanism and blood rheology. Method： Ninety children with HSPN were randomly divided into control group （45 cases） and observation group （45 cases） by random number table. Both groups＇ patients received conventional western therapy and received dipyridamole, tripterygium wilfordii polyglycoside and prednisone refer to different clinical feature. Based on control group, in observation group in the control group on basis of Zidianshen I number decoction, 1 dose/day. Course of treatment in two groups were 12 weeks. Hematuresis and proteinuria were monitored, and urine protein quantitation, blood rheology, fibrinogen （FIB）, D-dimer （D-D） and fibrin degradation products （FDP） were detected at 24 hours before and after treatment. Result： The total effective rate of disease curative effect in the observation group was 95.6% superior to 80% in the control group （P 〈 0.05）. After treatment, the level of red blood cell in urine and 24 hours urinary albumin in the observation group were lower than those in the control group （P 〈0.01 ）. And negative conversion ratio of red blood cell in urine of the observation group was 88.2% superior to 61.7% of the control group, negative conversion ratio of urinary albumin was 82.9% superior to 54. 1% incontrol group （P 〈 0.05）. the level of FIB, FDP and D-D in observation group were all lower than those in control group （P 〈 0.01 ）. The amelioration of whole blood viscosity （low or high shearing）, whole blood reduced viscosity （low or high shearing） , platelet aggregation rate and plasma viscosity of blood rheology index in observation group were superior to the control group （P 〈 0.01 ）. Conclusion： Based on conventional western therapy, Zidianshen Ⅰ number decoction can reduce red blood cell in urine and white blood cell in urine of children with HSPN and promote the negative conversion of red blood cell in urine cell and white blood cell in urine, the mechanism of action may be related to ameliorating clotting and blood rheology index and reducing high clotting condition.