益肾化湿颗粒辅助泼尼松治疗紫癜性肾炎63例分析

Analysis of 63 cases of Henoch-Schonlein purpura nephritis treated with Yishen Huashi granule combined by prednisone

目的探究益肾化湿颗粒辅助泼尼松治疗紫癜性肾炎(HSPN)病儿效果及对肾功能、T2和Th17细胞免疫应答的影响。方法采用信封法将2016年1月至2018年11月间郑州大学附属儿童医院收治的126例HSPN病儿分为常规组及联合组,每组63例。常规组采用泼尼松治疗,联合组在常规组基础上联合益肾化湿颗粒治疗。于治疗前及治疗8周后检测血清胱抑素C(CysC)、尿β2微球蛋白(β2⁃MG)、24 h尿微量白蛋白(24 hUmAlb)等肾功能指标,测定血清白介素⁃2(IL⁃2)、干扰素γ(IFN⁃γ)、白介素⁃5(IL⁃5)、白介素⁃10(IL⁃10)、白介素⁃17(IL⁃17)水平,评价疗效及安全性。结果常规组及联合组病儿治疗总有效率分别为82.54%、95.24%,联合组总有效率大于常规组(P<0.05);两组病儿治疗后CysC、β2⁃MG、24hUmAlb等肾功能指标明显下降(P<0.05),联合组各指标明显低于常规组(P<0.05);两组病儿治疗后IL⁃2、IFN⁃γ水平升高(P<0.05),IL⁃5、IL⁃10、IL⁃17水平降低(P<0.05),联合组病儿指标升高或降低幅度大于常规组(P<0.05)。结论益肾化湿颗粒辅助泼尼松治疗可调节机体免疫失衡状态,改善HSPN病儿肾功能,提高单一糖皮质激素治疗效果,安全性较好。

Objective To investigate the curative effect of Yishen Huashi Granule⁃assisted glucocorticoid on the sick children with henoch⁃schonlein purpura nephritis(HSPN)and the influences on renal function,Th1,Th2 and Th17 cell immune responses.Meth⁃ods A total of 126 children with HSPN treated in Children’s Hospital affiliated to Zhengzhou University from January 2016 to No⁃vember 2018 were divided into routine group and combination group by envelope method,with 63 cases in each group.The routine group was treated with prednisone,and the combined group was treated with Yishen Huashi Granule on the basis of routine group.Renal function indexes such as serum Cystatin C(CysC),urinaryβ2 microglobulin(β2⁃MG)and 24h urinary microalbumin(24hUmAlb)were measured before treatment and at 8 weeks after treatment.Levels of serum interleukin⁃2(IL⁃2)interferonγ(IFN⁃γ),interleukin⁃5(IL⁃5),interleukin⁃10(IL⁃10)and interleukin⁃17(IL⁃17)were measured.The curative effect and safety were evaluated.Results The total response rate of treatment in combination group was higher than that in routine group(95.24%vs.82.54%)(P<0.05).After treatment,renal function indexes such as CysC,β2⁃MG and 24hUmAlb in both groups were signifi⁃cantly decreased(P<0.05).The above indexes of combination group were significantly lower than those of routine group(P<0.05).After treatment,levels of IL⁃2 and IFN⁃γin both groups were increased(P<0.05),while levels of IL⁃5,IL⁃10 and IL⁃17 were decreased(P<0.05).The increase or decrease amplitude in combination group was greater than that in routine group(P<0.05).Conclusion Yishen Huashi Granule⁃assisted glucocorticoid therapy can regulate organism immune imbalance,improve re⁃nal function of HSPN patients,improve curative effect of single glucocorticoid,with relatively better safety.