健脾补肾法联合强的松对脾虚湿困型小儿肾病综合征骨代谢、尿β2-MG及α1-MG的影响

Effect of Nourishing Spleen and Kidney Method Combined with Prednisone Acetate Tablets on Bone Metabolism,Urine β2-MG and α1-MG of Pediatric Nephrotic Syndrome

目的：探讨健脾补肾法联合强的松对脾虚湿困型小儿肾病综合征骨代谢、尿β_2-微球蛋白（β_2-microglobulin,β_2-MG）及α_1-微球蛋白（α_1-microglobulin,α_1-MG）的影响。方法：收集2014年1月至2016年1月在郑州儿童医院治疗的NS患儿68例,按照入院编号和随机数字表进行分组,分为研究组和对照组,各34例,对照组给予基础性治疗和强的松治疗,在对照组的基础上,研究组给予补肾健脾法治疗,治疗周期为3个月。于治疗前后,测定血清白蛋白,骨钙素N-端中分子片段（N-MID）,骨钙素（BGP）,甲状腺旁激素（PTH）,骨特异性碱性磷酸酶（BALP）,24 h尿蛋白定量;观察两组的疗效,记录不良反应发生情况,并随访1年,记录复发情况。结果：两组患儿总有效率无明显差异。治疗后,两组中医证候评分均明显下降（P〈0.05）,且研究组治疗后中医证候评分低于对照组（P〈0.05）;研究组钙素N-MID,BGP明显增高（P〈0.05）,BALP,PTH明显降低（P〈0.05）,且研究组治疗后N-MID,BGP明显高于对照组（P〈0.05）,BALP,PTH明显低于对照组（P〈0.05）;两组尿β_2-MG及α_1-MG均明显下降（P〈0.05）,且研究组治疗后尿β_2-MG及α_1-MG均高于对照组（P〈0.05）;两组血清白蛋白均明显上升（P〈0.05）,24 h尿蛋白定量均明显下降（P〈0.05）;且研究组治疗后血清白蛋白均高于对照组（P〈0.05）,24 h尿蛋白定量低于对照组（P〈0.05）。两组不良反应发生率差异无统计学差异。随访1年中,研究组复发率17.65%（6/34）,对照组复发率47.06%（16/34）,研究组低于对照组（P〈0.05）。结论：健脾补肾法联合强的松治疗小儿肾病综合征的疗效较好,能缓解临床症状,改善骨代谢,调节尿β_2-MG及α_1-MG,保护肾损伤,且降低复发率。

Objective： To investigate the effect of nourishing spleen andkidney method combined with prednisone acetate tablets on bone metabolism,urine β_2-microglobulin（ β_2-MG） and α_1-microglobulin（ α_1-MG） of pediatric nephrotic syndrome（ NS）. Method： The 68 children with NS in our hospital from January 2014 to January 2016 were collected and divided into research group and control group in accordance with the admission number and random number table,34 cases in each group. The control group was given with basic treatment and prednisone treatment,and the research group additionally received nourishing kidney and spleen method treatment on the basis of treatment in control group. The treatment course was 3 months in both groups. Before and after treatment,the serum albumin,osteocalcin N-terminal molecular fragment（ N-MID）,bone glaprotein（ BGP）,porathroid hormone（ PTH）, bone specific alkaline phosphatase（ BALP）, and 24 h urinary protein were measured; the efficacy of two groups was observed; the adverse reactions were recorded; and the recurrence was recorded in one year follow up. Result： There was no significant difference in total effective rate between two groups. After treatment,traditional Chinese medicine（ TCM） symptom scores were significantly reduced in both groups（ P 0. 05）,and the TCM symptom scores in research group were lower than those in control group（ P 0. 05）. Calcitonin N-MID and BGP levels were significantly increased in research group（ P 0. 05）,and the BALP and PTH levels were decreased obviously（ P 0. 05）,and N-MID,BGP levels in research group were significantly higher,while BALP,PTH levels were significantly lower than those in control group after treatment（ P 0. 05）. The urine β_2-MG and α_1-MG levels were significantly decreased in both groups（ P 0. 05）,and those levels in research group were higher than those in control group（ P 0. 05）. The serum albumin was increased significantly in both groups（ P 0. 05）, and 24 h protein content was significantly decreased（ P 0. 05）. The serum albumin level in research group was higher than that in control group after treatment（ P 0. 05）,and 24 h protein content was lower than that in control group（ P 0. 05）. There was no significant difference in incidence of adverse reactions between two groups. In 1 year follow-up,the recurrence rate was17. 65%（ 6/34） in research group,lower than 47. 06%（ 16/34） in the control group（ P 0. 05）. Conclusion：Nourishing spleen and kidney method combined with prednisone acetate tablets is effective in treating pediatric nephrotic syndrome. It can relieve clinical symptoms,improve bone metabolism,regulate urine β_2-MG andα_1-MG,protect kidney injury and reduce the recurrence rate.