槐杞黄颗粒治疗过敏性紫癜性肾炎的效果及其对血清中细胞因子的影响

Clinical efficacy Huaiqihuang granules for purpura nephritis and its influence on the level of serum cytokine

目的探讨槐杞黄颗粒治疗过敏性紫癜性肾炎（henoch - Schonle in purpura nephritis, HSPN）的疗效及对血清中细胞因子的影响。方法将2008年11月-2013年1月收治的54例HSPN患者随机分为A组28例和B组26例，同期选取健康体检儿童50名作为C组，A、B组均按照常规治疗，泼尼松片1～2mg／（kg·d），晨顿服或分次口服，先服用4周，后根据尿常规变化渐减量，总疗程12周停药；在此基础上，B组加用槐杞黄颗粒，3岁者以下者，5g/次；超过3岁者，10g/次；均每日2次口服，疗程2—3个月。对比A、B两组疗效，并采用酶联免疫吸附法测定各组血清中细胞因子水平（IFN-γ，IL-21，IL-4，IL-10，TNF-α）。计量资料采用t检验，计数资料采用，检验，P〈0．05为差异有统计学意义。结果B组治愈22例，缓解5例，无效1例，总有效率96．4％；A组分别为16、4、6例，总有效率76．9％。两组比较差异有统计学意义（P〈0．05）。B组糖皮质激素疗程2—4周，A组4周，B组较A组明显缩短（P〈0．05）。治疗2个月后B组IL-21，IL-4，TNF—α显著降低，并低于A组（P〈0．05）。A、B组IFN-γ均低于C组（P〈0．05），治疗2个月后B组显著升高，并高于A组（P〈0．05），且接近C组水平。结论HSPN患儿治疗前IL-21，IL-4，IL-10，TNF—α的升高和IFN-γ的降低可能参与HSPN的发病，槐杞黄辅助治疗可以下调HSPN患儿IL-21，IL-4，TNF—α的表达，上调IFN-γ的表达，纠正Th1／Th2失衡，从而发挥免疫调节作用。

Objective To observe the clinical efficacy Huaiqihuang granules for purpura nephritis and its influence on the level of serum cytokine. Methods Fifty - four treated children with purpura nephritis were randomly divided into group A （ n = 28） and group B （ n = 26） from Nov. 2008 to Jan. 2013. Fifty healthy children were selected as the healthy controls （group C）. Both group A and B received conventional treatment, in which prednisone tablets were given, 1 -2 mg/（ kg · d） , in one or divided doses for 4 weeks, and then decreased based on the results of urinalysis and then abandoned after a total of a 12 - week treatment. Group B received oral Huaiqihuang granules in addition, 5g for children under the age of 3, 10g for children over the age of 3, twice a day, for 2 - 3 months. Clinical efficacy was compared in both group A and B. ELISA was used to measure the serum levels of cytokines （IFN -γ, IL -21, IL -4, IL- 10, TNF -α）. Measurement data were processed by t test, and count data by χ^2 test, the result of P 〈 0.05 was considered statistically significant. Resuits Group B ： 22 cases were cured, 5 cases improved, 1 case showed no response, the total effective rate was 96.4%. Group A： 16 cases were cured, 4 cases improved, 6 cases showed no response, the total effective rate was 76.9%. There was significant difference between the two groups （ P 〈 0.05 ）. Group B received glucocorticoids for 2 - 4 weeks, while group A for 4 weeks, the treatment course of glucocorticoids was significantly shorter in group B than in group A （ P 〈 0. 05 ）. After 2 - month treatment, the serum levels of IL - 21, IL - 4 and TNF - o decreased significantly in group B, which were lower than those in group （ P 〈 0. 05 ） ; the serum levels of IFN - α in both group A and B were lower than those in group C （ P 〈 0.05 ） ; the serum level of IFN -γ in group B increased, obviously and was higher than that of group A （ P 〈 0. 05 ） , close to that of group C. Conclusions The increased level of IL - 21, IL - 4, IL - 10, TNF-α and the decreased level of IFN -γ before treatment may play an important role in the pathogenesis of purpura nephritis. The adjuvant therapy of Huaiqihuang granules can down - regulate the expression of IL - 21, IL - 4, IL - 10, TNF - α and up - regulate the expression of IFN - γ, regulate Th1/Th2 balance, playing an important role in immune regulation.