清热凉血化瘀汤对血热夹瘀型紫癜性肾炎患儿Th17/Treg细胞及氧化应激的影响

Effect of Qingre Liangxue Huayu Decoction on Th17/Treg Cell and Oxidative Stress for Children with Blood-heat and Blood-stasis Type of Henoch-schonlein Purpura Nephritis

目的:观察清热凉血化瘀汤对血热夹瘀型紫癜性肾炎患儿Th17/Treg细胞及氧化应激的影响。方法:选择2016年2月~2017年2月期间在我院接受治疗的124例血热夹瘀型紫癜性肾炎患儿为研究对象,按随机数字表法分为两组,均62例。对照组采用常规西药治疗,实验组在常规西药治疗的基础上采用清热凉血化瘀汤治疗。比较治疗前后两组24小时尿蛋白定量、临床症状、辅助性T细胞17(Thelper cell 17,Th17)、调节性T细胞(Regulatory cell,Treg)、尿中氧化应激指标[丙二醇(Malonaldehyde,MDA)]水平的变化情况,并评价两组临床疗效及安全性。结果:实验组治疗总有效率为95.16%(59/62),明显高于对照组80.65%(50/62),差异具有统计学意义(P<0.05);和治疗前相比,两组24小时尿蛋白定量、中医症候积分、Th17细胞、尿MDA水平在治疗后均下降,而Treg细胞上升,差异具有统计学意义(P<0.05);治疗后,实验组24小时尿蛋白定量、中医症候积分、Th17细胞、尿MDA水平低于对照组,而Treg细胞高于对照组,差异具有统计学意义(P<0.05);两组患者在治疗过程中均未发生不良反应。结论:采用清热凉血化瘀汤治疗血热夹瘀型紫癜性肾炎,可明显提高临床疗效,缓解临床症状,减轻尿蛋白,促进患儿身体恢复,其作用机制可能与下调Th17细胞、上调Treg细胞表达及改善氧化应激有关。

Objective： To investigate the effect of Qingre Liangxue Huayu Decoction on ThlT/Treg cell and oxidative stress for children with blood-beat and blood-stasis type of henoch-schonlein purpura nephritis （HSPN）. Methods： 124children with blood-heat and blood-stasis type of HSPN in our hospital from February 2016to February 2017were selected as research object, and they were divided into two groups by random number table, 62cases in each. The controlled group was treated with conven- tional medicine, and the experimental group was treated with Qingre Liangxue Huayu Decoction based on the controlled group. The changes of 24h urine protein quantity, clinical symptoms, T helper cell 17 （ThlT）, T regulatory cell （Treg）, urinary oxidative stress index [ malonaldehyde （MDA） ] levels of the two groups before and after treatment were compared. The clinical effi- cacy and safety of the two groups were evaluated. Results： The total effective rate of the experimental group was 95.16% （59/ 62）, which was significantly higher than 80. 65% （50/62） of the controlled group （P〈O. 05） ; Compared with before treat- ment, the 24h urine protein quantity, TCM symptom score, Thl7cell, urinary MDA level of the two groups decreased after treatment, but Treg cell increased （P〈 0.05 ）; After treatment, the 24h urine protein quantity, TCM symptom score, ThlTcell, urinary MDA level of the experimental group were lower than those of the controlled group, but Treg cell was higher than the controlled group （ P〈0. 05 ） ; There was no adverse reactions in the two groups during treatment. Conclusion ： Qingre Liangxue Huayu Decoction for treating blood stasis type of HSPN can significantly increase clinical efficacy, releive clinical symp- toms, reduce urine protein and promote recovery of children, whose mechanism of action is likely to relate with down-regulating Th17cell, up-regulating Treg cell expression and improving oxidative stress.