系统性红斑狼疮住院患儿中西医结合治疗特点分析

Analysis of the Characteristics of Integrative Medicine Therapy for the Children with Systemic Lupus Erythematosus

目的:分析儿童系统性红斑狼疮(systemic lupus erythematosus,SLE)住院患者的中医辨证及中西医治疗特点,为儿童SLE中西医结合规范化治疗提供参考。方法:利用电子病历系统收集相关资料,回顾性分析本院近15年儿童SLE住院患者临床诊疗情况。结果:92.3%的患儿在儿科、皮肤科、肾科、风湿科住院治疗;病性以实证、虚实夹杂为主,多见脾肾阳虚、肝肾阴虚、阴虚内热、热毒炽盛等证型,治疗以健脾补肾、益气养阴、清热祛湿、活血化瘀为主,清热药、补虚药、祛湿药、活血药为中医治疗儿童SLE的主要药类;激素、中药、免疫抑制剂及免疫球蛋白常用于SLE的治疗;本组病例中西医结合治疗率达96.9%,总有效率为93.8%,平均住院日逐年下降。结论:“热”在儿童SLE发病过程中占据重要地位,“清热”疗法的灵活使用是中医药治疗儿童SLE的一个重要措施。现阶段,糖皮质激素联合中药是本院核心基础治疗方案,中西医结合诊疗可能在提高临床疗效的同时,也可能有助于控制医疗卫生费用,本院治疗方案可为儿童SLE中西医结合规范化治疗研究提供一些临床参考。

Objective:To provide the reference for integrative medicine standardized therapy of the children with systemic lupus erythematosus(SLE)by analyzing the characteristics of TCM syndrome differentiation and integrative medicine therapy of SLE inpatients.Methods:Electronic medical record system was adopted to collect the related data,clinical diagnosis conditions of SLE inpatients in our hospital were retrospectively analyzed in the recent 15 years.Results:All 92.3%of the children were hospitalized in pediatric department,dermatology department,renal department and rheumatology department;the nature of the disease was excess,intermingled excess and deficiency mainly,and the patterns were spleen-kidney Yang deficiency,liver and kidney Yin deficiency,Yin deficiency and internal heat,heat-toxin flaming and others mostly.Therapeutic principles were to invigorate spleen and kidney,tonify Qi and nourish Yin,clear heat and dampness,promote blood circulation and remove blood stasis mainly,the herbs of clearing-heat,tonification,clearing dampness and promoting blood circulation were the main medicines of TCM in treating SLE children;hormone,herbs,immunosuppressant and immunoglobulin were used in the therapy for SLE;Among the patients,integrative medicine therapeutic rate reached 96.9%,total effective rate was 93.8%,average hospitalization days reduced year by year.Conclusion:"Heat"plays an important role in the pathogenesis of SLE in children,and the flexible use of"clearing heat"therapy is an important measure to treat SLE in children.Currently,glucocorticoid combined with herbs are the core basic therapeutic regimen in our hospital,integrative medicine diagnosis and treatment might raise clinical effects,simultaneously,it is helpful to control medical and health cost.Therapeutic regimen in our hospital could provide clinical reference for integrative medicine standardized therapy of SLE in children.