中西医结合治疗儿童狼疮肾炎非随机对照研究

Non-randomized Controlled Study on the Treatment of Children Lupus Nephritis by Stages with Chinese Medicine

目的评价中西医结合分期治疗儿童系统性红斑狼疮肾炎的临床疗效。方法2018年1月—2020年1月收治的系统性红斑狼疮肾炎患儿87例,根据治疗方法分成中西医结合组(45例)和西药组(42例),对照组采用激素加环磷酰胺冲剂等西医常规治疗,观察组在西医常规治疗基础上加用中药分期治疗,治疗24周。观察2组治疗前后中医症候,尿检恢复及系统性红斑狼疮活动指数(SLEDAI)、补体、血沉、肝、肾功能等指标改善情况。结果共完成观察84例,脱落3例,观察组1例,对照组2例。治疗24周观察组总有效率97.7%(43/44),对照组92.5%(37/40),两组比较差异无统计学意义(P>0.05)。与本组治疗前比较,两组治疗4、12、24周后尿红细胞计数、蛋白尿定量、血沉及SLEDAI降低,血清白蛋白、补体升高(P<0.05,P<0.01);与对照组比较,治疗4周观察组中医症候积分、尿红细胞计数、蛋白尿定量、血沉降低及血红蛋白升高(P<0.05);治疗24周中医症候积分下降、尿红细胞计数减少、蛋白尿定量及补体C4水平下降(P<0.05)。结论在西药治疗基础上加用中药分期论治儿童狼疮肾炎,有利于疾病的缓解。

Objective To evaluate the clinical efficacy of integrated Chinese and Western medicine in children with systemic lupus erythematosus nephritis by stages.Methods Total 87 children with systemic lupus erythematosus nephritis from January 2018 to January 2020 were assigned into observation group(45 cases)and control group(42 cases).The control group was treated with hormone and cyclophosphamide granules as the conventional Western medicine treatment,and the observation group was treated with Chinese medicine(CM)on the basis of conventional Western medicine treatment.The treatment lasted for 24 weeks.The CM symptoms,urine test recovery,systemic lupus erythematosus disease activity index(SLEDAI),complement and erythrocyte sedimentation rate(ESR),liver and renal function of the two groups before and after treatment were observed.Results Eighty-four patients completed the test,and 3 cases fell off,1 case in observation group,2 cases in control group.After 24 weeks of treatment,the total effective rate of the observation group was 97.7%(43/44),and that of the control group was 92.5%(37/40).There was no significant difference between the two groups(P>0.05).Compared with before treatment,urine red blood cell count,proteinuria,ESR and SLEDAI decreased after 4,12 and 24 weeks of treatment,while serum albumin and complement increased(P<0.05,P<0.01).Compared with the control group,the CM syndrome score,urinary red blood cell count,proteinuria,ESR decreased and hemoglobin increased in the observation group after 4 weeks of treatment(P<0.05).After 24 weeks of treatment,the scores of CM symptoms,urinary red blood cell count,proteinuria and complement C4 levels decreased(P<0.05).Conclusion The treatment of children with systemic lupus erythematosus nephritis by stages on the basis of Western medicine treatment is conducive to the remission of the disease.