激素联合归芍地黄丸和玉屏风散序贯治疗肝肾阴虚型小儿肾病综合征50例疗效分析

Analysis of corticosteroids combined with sequential therapy of Chinese Guishao Dihuang pill and Yupingfeng granules on 50 cases with yin deficiency of liver and kidney and nephrotic syndrome in children

目的探讨激素联合归芍地黄丸和玉屏风散序贯治疗肝肾阴虚型小儿肾病综合征（NS）的临床疗效。方法选择2012年1月至2016年6月赣南医学院第一附属医院儿科收治的确诊为肝肾阴虚型NS初治患儿（治疗过程中的脱失患儿未列入统计）50例，按随机数字表法分为对照组和观察组，每组25例。两组均给予西医常规治疗及皮质激素长程疗法，观察组在西医常规治疗基础上序贯给予归芍地黄丸和玉屏风散颗粒剂。观察治疗前和治疗8周、6个月血小板聚集率（PAT）、胆固醇、皮质醇、T细胞亚群CD3、CD4、CD4／CD8的变化，比较两组临床疗效及感染等并发症发生情况。结果两组治疗前、治疗8周和6个月胆固醇、皮质醇及临床疗效比较差异均无统计学意义（均P〉0．05）。两组治疗后8周和6个月PAT、胆固醇、皮质醇较治疗前明显降低，CD3、CD4较治疗前明显升高，且观察组PAT、CD3、CD4的变化较对照组更显著[PAT：治疗后8周为（63．01±6．99）％比（66．62±4．65）％，治疗后6个月为（51．42±7．74）％比（57．01±6．77）％，CD3：治疗后8周为0．56±0．06比0．52±0．06，治疗后6个月为0．61±0．05比0．58±0．03，CD4：治疗后8周为0．33±0．06比0．30±0．05，治疗后6个月为0．39±0．05比0．33±0．06，均P〈0．05]。观察组治疗后8周和6个月CD4／CD8比值较治疗前明显升高（1．68±0．76、1．82±0．95比1．16±0．67，均P〈0．05）；观察组感染病例数较对照组明显下降（86例次比175例次，P〈0．05）。结论激素联合归芍地黄丸和玉屏风散序贯治疗小儿肝肾阴虚型NS均较单用西医疗法在抗血栓形成、提高免疫及减少感染方面疗效良好。

ObjectiVe To explore the clinical effect of corticosteroids combined with Chinese medicine sequential therapy of Guishao Dihuang pill and Yupingfeng granules on children nephrotic syndrome （NS） with yin deficiency of liver and kidney. Methods Fifty patients （the loss of children during the course of treatment were not included in the statistical analysis） with definitely diagnosed NS accompanied by yin deficiency of the liver and kidney admitted to the First Affiliated Hospital of Gannan Medical University from January 2012 to June 2016 were enrolled, and they were divided into control group and observation group by random number table, 25 cases in each group. Conventional treatment of western medicine and long-term treatment of corticosteroids were given to the two groups. In addition, sequential therapy of Guishao Dihuang pills and Yupingfeng granules was given to the observation group on the bases of conventional treatment. The changes of platelet aggregation rate （PAT）, cholesterol, cortisol, T cell subsets CD3, CD4, CD4/CD8 were observed before and after treatment for 8 weeks and 6 months, then the clinical efficacy and infection, etc. complications were compared between the two groups. Results There were no statistical significant differences in cholesterol, cortisol and curative effect compared between the two groups before treatment and after treatment for 8 weeks and 6 months （all P 〉 0.05）. After treatment for 8 weeks and 6 months, the PAT, cholesterol, cortisol of two groups were significantly decreased compared with those before treatment, while CD3, CD4 were obviously higher than those before treatment, and the degrees of changes of PAT, CD3, CD4 in the observation group were more remarkable than those of the control group [PAT： treatment after 8 weeks was （63.01 ± 6.99）% vs. （66.62 ± 4.65）%, treatment after 6 months was （51.42 ± 7.74）% vs. （57.01 ± 6.77）%, CD3： treatment after 8 weeks was 0.56 ± 0.06 vs. 0.52 ± 0.06, treatment after 6 months was 0.61 ± 0.05 vs. 0.58 ± 0.03, CD4： treatment after 8 weeks was 0.33 ± 0.06 vs. 0.30 ± 0.05, treatment after 6 months was 0.39 ± 0.05 vs. 0.33 ± 0.06, all P 〈 0.05]. CD4/CD8 ratio was significantly higher in observation group after treatment for 8 weeks and 6 months than those before therapy （1.68 ± 0.76, 1.82 ± 0.95 vs. 1.16 ± 0.67, both P 〈 0.05）; the number of patients with infection in observation group was obviously lower than that of the control group （86 cases vs. 175 cases, P 〈 0.05）. Conclusions The therapeutie effect of corticosteroids combined with Chinese medicine sequential therapy of Guishao Dihuang pills and Yupingfeng granules for treatment of children NS with yin deficiency of the liver and kidney is better than that of using western medicine therapy alone, as the combined sequential therapy has good effects on reduction of infection, anti-thrombosis and elevation of immunity.