健脾补肾活血利水方辅助治疗儿童原发性肾病综合征中远期疗效观察

Medium-long term efficacy of Jianpi Bushen Huoxue Lishui Decoction for children with primary nephrotic syndrome

目的观察健脾补肾活血利水方治疗儿童原发性肾病综合征(PNS)的中远期疗效。方法将71例PNS患儿按照随机数字表法分为2组,对照组35例予醋酸泼尼松片治疗,治疗组36例在对照组治疗基础上加健脾补肾活血利水方治疗。比较2组用药后水肿消退时间、尿蛋白转阴时间,治疗3个月临床疗效,治疗前及治疗3个月后血清白蛋白(ALB)、24 h尿蛋白定量、β_(2)-微球蛋白(β_(2)-MG)、可溶性髓样细胞触发受体-1(sTREM-1)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)、白细胞介素13(IL-13)水平,随访5年记录2组复发情况。结果治疗组显效率91.66%(33/36),对照组显效率71.43%(25/35),治疗组显效率高于对照组(P<0.05)。治疗组水肿消退时间、尿蛋白转阴时间均早于对照组(P<0.05)。治疗3个月,2组ALB、IL-13水平均较本组治疗前升高,24 h尿蛋白定量、β_(2)-MG、sTREM-1、suPAR水平均降低(P<0.05),且治疗组ALB、IL-13水平高于对照组(P<0.05),24 h尿蛋白定量、β_(2)-MG、sTREM-1、suPAR水平低于对照组(P<0.05)。随访期间,对照组失访2例,治疗组失访1例,治疗组3年复发率(2.86%)、5年复发率(5.71%)均低于对照组(18.18%,24.24%),比较差异有统计学意义(P<0.05)。结论健脾补肾活血利水方可有效缓解PNS患儿临床症状,降低患儿机体炎症,改善肾功能及免疫功能,降低中远期复发率,临床疗效满意。

Objective To observe the medium-long term efficacy of Jianpi Bushen Huoxue Lishui Decoction for children with primary nephrotic syndrome(PNS).Methods Totally 71 children with PNS were randomly assigned to receive either prednisone acetate tablets(the control group,n=35)or prednisone acetate tablets+Jianpi Bushen Huoxue Lishui Decoction(the treatment group,n=36).The edema disappearance time,negative conversion time of urine protein,the clinical efficacy on month 3,the serum albumin(ALB),24-h urine protein excretion(24-hUPE),β_(2)-microglobulin(β_(2)-MG),the soluble triggering receptor expressed on myeloid cells(sTREM-1),soluble urokinase plasminogen activator receptor(suPAR),interleukin-13(IL-13)on day 0 and on month 3 were included as comparators.A 5-year follow-up of recurrence rate was assessed.Results The obvious effective rate in the treatment group was better than that in the control group(91.66%[33/36]vs 71.43%[25/35],[P<0.05],respectively).After treatment,the edema disappearance time and negative conversion time of urine protein in the treatment group were earlier than those in the control group(P<0.05).On month 3,ALB and IL-13 in groups were increased,while 24-hUPE,β_(2)-MG,sTREM-1,suPAR were decreased;elevated levels of ALB and IL-13,and reduced levels of 24-h UPE,β_(2)-MG,sTREM-1,suPAR were detected in the treatment group than those in the control group(all P<0.05).During follow-up,2 cases in the control group and 1 case in the treatment group had been lost.The 3-,5-year recurrence rate were significantly lower in the treatment group than those in the control group([2.86%vs 18.18%],[5.71%vs 24.24%];[P<0.05],respectively).Conclusion For children with PNS,Jianpi Bushen Huoxue Lishui Decoction can effectively relieve clinical symptoms,reduce the inflammatory state,improve renal function and immune function,reduce the medium-long term recurrence rate,and with a satisfactory clinical effect.