凉血解毒活血法联合西药治疗紫癜性肾炎Ⅲ型的疗效特点

Clinical effect characteristics of Liangxue Jiedu Huoxue method combined with western medicine in treatment of Henoch-Sch?nlein purpura nephritis type Ⅲ

目的:探讨紫癜性肾炎(HSPN)高凝状态与肾脏损伤程度的关联,并观察凉血解毒活血法联合西药治疗对HSPNⅢ型高凝状态和24h尿蛋白定量(24 hUP)、尿红细胞计数(URBC)、尿总蛋白(UTP)、尿微量白蛋白(UMALB)、尿免疫球蛋白G(UIg G)的影响。方法:选取HSP 40例,HSPNⅡ型40例,HSPNⅢ型50例。全自动血凝仪检测3组血浆凝血六项的水平。HSPNⅢ型患儿根据治疗方案不同分为中西医结合治疗组(犀角地黄汤加减联合西药治疗)30例和西医对照组20例。观察两组治疗前和治疗1个月后凝血六项、24 hUP、URBC、UTP、UMALB、UIgG的变化。结果:治疗前,HSPNⅢ型组纤维蛋白原(FIB)、D-二聚体(DD)、纤维蛋白原降解产物(FDP)水平较HSPNⅡ型组、HSP组明显升高(P<0.05),其中血浆FIB与24 hUP和URBC的相关系数分别为0.541、0.305;血浆DD、FDP与URBC的相关系数分别为0.715、0.601。治疗1个月后,HSPNⅢ型两组血浆FIB、24 hUP、URBC、UTP/UCR、UMALB/UCR的水平较治疗前均显著降低(P<0.05)。与西医对照组比较,中西医结合治疗能显著降低血浆FIB、DD、FDP、URBC及UIgG/UCR的水平(P<0.05)。结论:凉血解毒活血法联合西药治疗能够有效降低HSPNⅢ型血浆FIB、DD及FDP,从而改善高凝状态,减少尿红细胞和尿IgG,减轻肾脏损伤。

Objective:To investigate the relationship between hypercoagulable state and renal injury in HenochSch?nlein purpura nephritis(HSPN),and to observe the effects of Liangxue Jiedu Huoxue method combined with western medicine treatment on the hypercoagulable state,24 h urinary protein quantification(24 hUP),urine red blood cell(URBC),urinary total protein(UTP),urine microalbuminuria(UMALB),and urine immunoglobulin G(UIgG)in children with HSPN typeⅢ.Methods:Forty children with HSP,40 children with HSPNⅡ,and 50 children with HSPNⅢwere included.The levels of six items of blood coagulation were detected by automatic coagulation analyzer.According to different treatment schemes,HSPN typeⅢchildren were divided into the integrated Chinese(Xijiao Dihuang Decoction)and western medicine treatment group(30 cases)and western medicine control group(20 cases).The levels of six items of blood coagulation,24 hUP,URBC,UTP,UMALB,and UIgG were observed before and after treatment for 1 month.Results:Before treatment,the levels of plasma fibrinogen(FIB),D-Dimer(DD),and fibrinogen degradation products(FDP)in HSPNⅢtype group were significantly higher than those in HSPNⅡtype group and HSP group(P<0.05).The correlation coefficients of plasma FIB with 24 hUP and URBC were respectively 0.541 and 0.305,and the correlation coefficients of plasma DD,FDP,and URBC were 0.715 and 0.601 respectively in HSPNⅢtype group.After 1 month of treatment,the levels of FIB,24 hUP,URBC,UTP/UCR,and UMALB/UCR were significantly lower than those before treatment in the integrated Chinese and Western medicine treatment group,and the western medicine control group(P<0.05).Compared to western medicine treatment,integrated traditional Chinese and Western medicine treatment decreased plasma FIB,DD,FDP,URBC,and UIgG/UCR levels(P<0.05).Conclusion:Liangxue Jiedu Huoxue method combined with western medicine treatment can effectively decrease the levels of plasma FIB,DD,and FDP in children with HSPNⅢtype,then improve high coagulation state,reduce the levels of urine red blood cell,urine IgG,and alleviate kidney injury.