加味附子理中汤对药物性急性肾损伤患者T淋巴细胞亚群及血管性假血友病因子的影响

Effect of Jiawei Fuzi Lizhong decoction on Cys C,T lymphocyte subsets and vWF of patients with acute drug-induced renal damage

目的观察加味附子理中汤对药物性急性肾损伤脾阳虚证患者血清胱抑素C(cystatin C,Cys C)、T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)及血管性假血友病因子(von Willebrand factor,vWF)的影响。方法选择2013年6月至2015年6月广西中医药大学第一附属医院门诊或住院的药物性急性肾损伤患者92例,按随机数字表分为研究组和对照组,每组46例;治疗过程中经排除脱落、终止病例等,实际纳入研究病例78例,其中研究组44例,对照组34例。对照组予基础治疗(立即停用肾损害的药物,卧床休息,给予低盐、低脂及优质蛋白质饮食,预防感染,控制血压及对症治疗)的同时加用醋酸泼尼松片,研究组在对照组治疗基础上加用加味附子理中汤,2组疗程均为4周。另设健康体检者30名为健康对照组,予抽血行T淋巴细胞亚群、vWF检测。观察2组患者治疗前后肾功能、T淋巴细胞亚群及vWF因子的变化,同时将研究组、对照组患者治疗前T淋巴细胞亚群、vWF水平与健康组进行比较。结果研究组与对照组经治疗后肾功能均改善,血尿素氮、血肌酐、血清Cys C水平较治疗前下降,差异均有统计学意义(P<0.01或P<0.05),研究组治疗后肾功能改善较对照组明显(P<0.01);药物性急性肾损伤患者免疫功能较健康人群明显下降,而vWF水平较健康人群明显上升,差异有统计学意义(P<0.01);研究组患者治疗后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平均上升,vWF水平明显下降,与治疗前比较,差异均有统计学意义(P均<0.01);对照组治疗前后免疫功能、vWF无明显变化,差异无统计学意义(P>0.05)。结论加味附子理中汤能改善药物性急性肾损伤患者肾功能,下调血清Cys C水平,且能提高患者免疫功能及下调vWF水平。

Objective To observe the effect of Jiawei Fuzi Lizhong decoction on Cystatin C（Cys C）,T lymphocyte subsets and von Willebrand factor（ v WF） of patients with acute drug-induced renal damage and spleen yang deficiency. Methods Ninety-two eligible patients were randomly divided into treatment group and control group with 46 cases in each group,and in fact,78 cases were studied,because some patients due to termination and abscission were excluded from the course of treatment. The 78 patients were divided into the treatment group（ n = 44） and the control group（ n = 34）. The control group was treated with prednisone acetate tablets as well as basic treatment for 4 weeks,and the treatment group was treated with Jiawei Fuzi Lizhong decoction on the basis of the treatment of the control group for 4weeks. Thirty healthy subjects served as healthy control group. Blood samples were taken to detect T lymphocyte subsets and v WF. Results After treatment,the renal function of treatment group and control group were improved,and the levels of BUN,SCr and Cys C decreased as compared with those before treatment,with the difference being statistically significant. The improvement of renal function in the treat-ment group was more significant than that in the control group（ P 0. 01）. The immune function in the patients with acute drug-induced renal damage was obviously lower than that in the healthy people,and the v WF level in patients with acute drug-induced renal impairment was significantly higher than that in the healthy people,with the difference being statistically significant（ P 0. 01）. After treatment,the levels of CD3~＋,CD4~＋,CD8~＋and CD4~＋/CD8~＋increased in the treatment group,and the v WF levels in the treatment group decreased obviously,but there were no obvious changes in T lymphocyte subsets and v WF in the control group before and after treatment. Conclusions Jiawei Fuzi Lizhong decoction can not only improve renal function of patients with acute drug-induced renal damage,but also improve the immune function and decrease the v WF level.