雷公藤多苷联合丹参注射液治疗过敏性紫癜性肾炎患儿对凝血机制的影响及疗效评价

Effect of Multi Glycosides Combined with Salvia Miltiorrhiza Injection on Blood Coagulation Mechanism in Children with Allergic Purpura Nephritis

目的:探讨雷公藤多苷联合丹参注射液治疗过敏性紫癜性肾炎患儿对凝血机制的影响,并进行疗效评价。方法:过敏性紫癜性肾炎患儿103例根据随机数字表分为常规治疗组51例和联合治疗组52例。常规治疗组采用饮食控制、激素、抗凝和雷公藤多苷片治疗,联合治疗组在常规治疗组基础上加用丹参注射液静脉滴注。观察两组治疗前后凝血指标(D-二聚体、抗凝血酶Ⅲ、凝血酶时间、凝血酶原时间、活化部分凝血时间、纤维蛋白原、血小板)和血栓弹力图[凝血反应时间(R)、凝血形成时间(K)、α角、最大振幅(MA)、血凝块溶解百分比(EPL)、凝血指数(CI)、30 min血凝块幅度减少速率(Ly30)]变化,观察皮肤紫癜、关节痛、腹痛、黑变和(或)便血消失时间及不良反应发生情况,随访6个月观察患儿过敏性紫癜、过敏性紫癜性肾炎复发情况,并对两组治疗效果进行评价。结果:两组治疗后D-二聚体、抗凝血酶Ⅲ、凝血酶时间、凝血酶原时间、活化部分凝血时间、纤维蛋白原、血小板、R、K、MA、EPL、Ly30水平与治疗前比较,差异有统计学意义(P<0.05),但常规治疗组凝血酶时间、凝血酶原时间与治疗前比较,差异无统计学意义(P>0.05)。联合治疗组治疗后D-二聚体、纤维蛋白原、血小板、MA、EPL水平低于常规治疗组,而抗凝血酶Ⅲ、凝血酶时间、凝血酶原时间、K水平高于对照组,差异有统计学意义(P<0.05)。联合治疗组皮肤紫癜、关节痛、腹痛、黑变和(或)便血消失时间均少于常规治疗组,差异有统计学意义(P<0.05)。常规治疗组不良反应发生率为7.8%,联合治疗组为5.8%,差异无统计学意义(P<0.05)。两组患儿随访6个月,过敏性紫癜、过敏性紫癜性肾炎复发率比较,差异无统计学意义(P>0.05)。两组疗效比较,差异有统计学意义(P<0.05)。结论:雷公藤多苷联合丹参注射液治疗过敏性紫癜性肾炎患儿能够显著改善患儿凝血情况和临床症状,无明显不良反应情况发生,疗效确切,有可能降低复发率。

Objective：To investigate the effects of triptelygium glycosides combined with Danshen Injection in the treat- ment of children with Henoch Schonlein purpura nephritis on coagulation mechanism and evaluate the curative effect. Methods ：A total of 103 cases with Henoch Schonlein purpura nephritis according to the random number table were divided into 51 cases of conventional treatment group and 52 cases of combined treatment group. Conventional treatment group received diet control, hormone treatment, anticoagulation and Tripterygium wilfordii glycosides tablet. The combined treatment group combined with Salvia Miltiorrhiza Injection. To observe the coagulation indexes of the 2 groups before and after treatment （ D - D dimer, antithrombin III, thrombin time, prothrombin time, activated partial prothrombin time, fibrinogen, platelet） and Thrombelastogram [ coagulation time （R） , coagulation time （K） , alpha angle, maximum amplitude （MA）, blood clot lysis percentage （EPL） , blood coagulation index （CI） , 30 rain blood clot amplitude reduction rate （Ly30） changes. The skin purpura, joint pain, abdominal pain, hematochezia and （or） disappearance time and the incidence of adverse reactions were followed up for 6 months to observe the recurrence of allergic purpura and Henoch Schonlein purpura nephritis and to evaluate the therapeutic effect of 2 groups. The two groups＇D -D dimer, antithrombin III thrombin,time, prothrombin time, activated partial prothrombin time, fibrinogen, platelet, R, K, MA, EPL and Ly30 levels after treatment was statistically significant （P 〈 0.05 ）, but the conventional treatment group＇s thrombin time and prothrombin time was not statistically significant compared with those before treatment（ P 〉 0.05 ）. After treatment,two groups＇D - D dimer, fibrinogen, platelet, MA and EPL levels were lower than those of the conventional treatment group, and antithrombin III, thrombin time, prothrombin time and K levels higher than those of the control group and the difference was statistically significant （P 〈 0.05 ）. The combined treatment group＇s curative effect of leucoderma, joint pain, abdominal pain, blackening and （or） hematochezia disappearance time were less than those of the conventional treatment group and the difference was statistically significant （P 〈 0.05）. Conventional treatment group＇s adverse reaction rate was 7.8% and the combined treatment group＇s was 5.8%. The difference was not statistically significant （P 〈 0.05）. Two groups＇ patients were followed up for 6 months. The allergic purpura and allergic purpura nephritis recurrence rate were not statistically significant （P 〉 0.05 ）. And the difference was statistically significant （P 〈 0.05 ）. Con- clusion ： Tripterygium glycosides combined with Salvia miltiorrhiza Injection in the treatment of allergic purpura nephritis in children can significantly improve the patients＇ coagulation and clinical symptoms and no obvious adverse reactions occurred. The urative effect is exact, and may reduce the recurrence rate.