白芍总苷佐治血尿和蛋白尿型紫癜性肾炎的临床效果及对血清细胞因子的影响

Clinical Effect of Total Glucosides of Paeonia as the adjuvant therapy on Hematuria and Proteinuria Purpura Nephritis and Its Effect on Serum Cytokines

目的探讨白芍总苷(total glucosides of paeony,TGP)佐治血尿和蛋白尿型紫癜性肾炎(henoch-schonlein purpura nephritis,HSPN)的效果及对血清白细胞介素6(interleukin-6,IL-6)、白细胞介素1β(interleukin-1β,IL-1β)及白细胞介素18(interleukin-18,IL-18)的影响.方法选取徐州医科大学附属医院儿科2017年6月至2018年12月收治的64例初发血尿和蛋白尿型紫癜性肾炎的患儿为研究对象,按随机数字法分为对照组(33例)和观察组(31例).对照组给予口服醋酸波尼松治疗,观察组在对照组的基础上联合白芍总苷治疗,两组均连续治疗4周.比较两组患儿治疗前和治疗后血清IL-6、IL-1β及IL-18的表达水平以及尿红细胞计数(urinary redblood cell,URBC)、24 h尿蛋白定量、尿免疫球蛋白G(urinary immunoglobulin G,IGU)、尿微量白蛋白(urinary microalbumin,MAU)、α1-微球蛋白(α1-microglobulin,α1-MG)、尿转铁蛋白(urinary transferrin,UTFR)等临床指标水平.结果治疗4周后观察组临床总有效率[93.5%(29/31)]明显高于对照组[72.7%(24/33)],两组比较差异有统计学意义(χ^2=4.868,P<0.05).治疗前观察组和对照组血清IL-6、IL-1β、IL-18与各临床指标水平差异无统计学意义(P 均>0.05),观察组治疗后与治疗前血清IL-6[(16.68±6.83)ng/L 与(32.24±6.99)ng/L,t=12.373]、IL-1β[(63.83±8.97)ng/L与(85.59±9.42)ng/L,t=9.758]、IL-18 [(64.52±5.46)ng/L与(88.50±5.54)ng/L,t=18.899]、24 h尿蛋白定量[0.30(0.21,0.36)g/24 h与1.00(0.65,1.23)g/24 h,Z=-4.861]、URBC[ 15.30 (3.80,36.80)×106 个/L 与168.90 (58.4, 324.0)×106 个/L,Z=-4.840]相比较,均明显降低(P均<0.05);对照组治疗后与治疗前血清IL-6 [(23.62±5.95)ng/L与(33.44±4.68)ng/L,t=9.149]、IL-1β[(68.67±6.31)ng/L与(86.59±8.71)ng/L,t=10.617]、IL-18[(71.25±9.69)ng/L与(89.87±6.68)ng/L,t=11.506]、24 h 尿蛋白定量[0.42(0.33,0.56)g/24与0.94(0.74,1.25)g/24 h,Z=-5.013]、URBC[57.00(39.25,77.50)×106个/L与145.60(58.20,360.85)×106 个/L,Z=-4.762]相比较,均明显降低(P均<0.05),且组间比较差异有统计学意义(P均<0.05).结论白芍总苷佐治血尿和蛋白尿型紫癜性肾炎具有明显的临床效果,可降低患儿的血尿和蛋白尿水平,改善患儿的肾脏症状;其可能的作用机制是通过下调血清IL-6、IL-1β、IL-18的表达,从而减轻肾脏炎症反应,起到保护肾脏的作用.

Objective To investigate the efficacy of total glucosides of paeony (TGP)in the treatment of hematuria and proteinuria purpura nephritis (HSPN)and serum interleukin-6 (IL-6), interleukin-1 beta (IL-1 beta)and interleukin-18 (IL-18). Methods From June 2017 to December 2018, 64 cases of children with primary hematuria and proteinuria purpura nephritis admitted to the department of pediatrics affiliated hospital of Xuzhou medical university were selected as study subjects, and were divided into control group (33 cases)and observation group (31 cases)according to random number method.The children in the control group were given oral administration of poniasone acetate, and the observation group was treated with TGP on the basis of the control group.Both groups received continuous treatment for 4 weeks.Two groups′ before and after treatment expression level of serum interleukin-6, interleukin-1β and interleukin-18, and level of clinic indicator such as Urinary red biood cell (URBC), 24 hour urinary protein quantity, urinary immune globulin G (IGU), micro-albuminuria (urinary microalbumin, MAU),α-Microglobulin (α1-MG)and urinary transferrin (TFRU)is made a comparison. Results After 4weeks of treatment, the total clinical effective rate of the observation group (93.5%(29/31))was significantly higher than that of the control group (72.7%(24/33)), and the difference between the two groups was statistically significant (χ^2=4.868, P<0.05). Before treatment, difference between serum interleukin-6, interleukin-1β and interleukin-18 from two groups and each clinic indicators level has no statistic significance (all P>0.05). After treatment, in the observation group, Serum IL-6 ((16.68±6.83)ng/L and (32.24±6.99)ng/L, t=12.373), IL-1β((63.83±8.97)ng/L and (85.59±9.42)ng/L, t=9.758), IL-18((64.52±5.46)ng/L and (88.50±5.54)ng/Ll, t=18.899), 24 h urinary protein quantification (0.3 (0.21, 0.36)g/24 h and 1.0 (0.65, 1.23)g/24 h, Z=-4.861), URBC (15.30 (3.80, 36.80)×106/L and 168.9 (58.4, 324.0)×106/L, Z=-4.840), were lower than before treatment (all P<0.05);After treatment, in the control group, Serum IL-6 ((23.62±5.95)pg/ml and (33.44±4.68)pg/ml, t=9.149), IL-1β((68.67±6.31)pg/ml and (86.59±8.71)pg/ml, t=10.617), IL-18((71.25±9.69)pg/ml and (89.87±6.68)pg/ml, t=11.506), 24 h urinary protein quantification (0.42 (0.33, 0.56)g/24 h and 0.94 (0.74, 1.25)g/24 h, Z=-5.013), URBC (57.00 (39.25, 77.50)×106/L and 145.60 (58.20, 360.85)×106/L, Z=-4.762), were lower than before treatment (all P<0.05). The difference between the two groups was statistically significant (P<0.05). Conclusion The adjuvant effect of total glucoside of white peony root on hematuria and proteinuria purpura nephritis is significant, which can reduce the level of hematuria and proteinuria and improve the renal symptoms of children.Its mechanism of action may be to reduce renal inflammation and protect the kidney by down-regulating the expression of serum IL-6, IL-1 and IL-18.