加味防己黄芪汤辅助治疗儿童肾病综合征风水相搏证40例临床观察

Clinical observation on 40 cases of modified Fangji Huangqi Tang(防己黄芪汤)in adjuvant treatment of children nephrotic syndrome with fighting of wind with water syndrome

目的观察加味防己黄芪汤辅助治疗儿童肾病综合征(NS)风水相搏证的临床疗效。方法选取2016年1月至2020年12月温州市中西医结合医院中医儿科收治的NS风水相搏证患儿80例,按数字奇偶法分为治疗组和对照组,各40例。对照组根据患儿病情予以抗凝血、抗感染以及扩容利尿消肿、保护胃黏膜等对症治疗,控制血压,并予醋酸泼尼松片口服;治疗组在对照组治疗方法的基础上予加味防己黄芪汤治疗。2组均连续治疗12周后统计临床疗效。结果对照组总有效率为67.50%(27/40),治疗组为87.50%(35/40),2组比较,差异有统计学意义(P<0.05)。治疗前2组24 h尿蛋白定量、血浆白蛋白(ALB)及总胆固醇(TC)水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组24 h尿蛋白定量、血浆TC水平明显下降,血浆ALB水平明显升高,与同组治疗前比较,差异均有统计学意义(P<0.05),且治疗组下降或升高更显著(P<0.05)。治疗前2组血清肌酐(Scr)、肌酐清除率(Ccr)、血尿素氮(BUN)水平比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组Scr、BUN水平明显下降,Ccr水平明显升高,与同组治疗前比较,差异均有统计学意义(P<0.05),且治疗组下降或升高更显著(P<0.05)。治疗前2组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组PT、APTT均显著延长,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组延长更显著(P<0.05)。结论加味防己黄芪汤辅助治疗小儿NS风水相搏证,能明显降低患儿的尿蛋白、TC水平,纠正低蛋白血症,改善肾功能,疗效显著,值得临床推广应用。

Objective To observe the clinical efficacy of modified Fangji Huangqi Tang(防己黄芪汤)in adjuvant treatment of children nephrotic syndrome(NS)with fighting of wind with water syndrome.Methods From January 2016 to December 2020,80 children of NS with fighting of wind with water syndrome were selected from Department of TCM Pediatrics of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital.They were divided into a treatment group and a control group according to the digital parity method,with 40 cases in each group.The control group was given symptomatic treatment such as anticoagulation,anti-infection,dilatation,diuresis,detumescence,protection of gastric mucosa,control of blood pressure,and oral prednisone acetate tablets;the treatment group was treated with modified Fangji Huangqi Tang on the basis of the treatment method of the control group.Both groups were treated continuously for 12 weeks,and the clinical efficacy was counted.Results The total effective rate was 67.50%(27/40)in the control group and 87.50%(35/40)in the treatment group.The difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference between the two groups in 24 hours urine protein content,plasma albumin(ALB)and cholesterol(TC)levels before treatment(P>0.05),which was comparable;after treatment,the urine protein quantity,plasma TC level and plasma ALB level in the two groups decreased significantly at 24 hours,compared with the same group before treatment,the difference was statistically significant(P<0.05),and the decrease or increase in the treatment group was more significant(P<0.05).There was no statistically significant difference in serum creatinine(Scr),creatinine clearance rate(Ccr)and blood urea nitrogen(BUN)between the two groups before treatment(P>0.05),which was comparable;after treatment,the levels of Scr and BUN in the two groups decreased significantly,while the level of Ccr increased significantly.Compared with the same group before treatment,the difference was statistically significant(P<0.05)and the decrease or increase in the treatment group was more significant(P<0.05).There was no statistically significant difference in prothrombin time(PT)and activated partial thromboplastin time(APTT)between the two groups before treatment(P>0.05),which was comparable;after treatment,the PT and APTT levels in both groups were significantly higher than those in the same group before treatment.Compared with the same group before treatment,the difference was statistically significant(P<0.05),and the increase was more significant in the treatment group(P<0.05).Conclusion It can significantly reduce the level of urine protein and total cholesterol,correct hypoproteinemia and improve renal function in children with NS syndrome of fighting of wind with water syndrome to use modified Fangji Huangqi Tang in adjuvant treatment,which is worthy of clinical promotion and application.