参芪地黄汤加减治疗紫癜性肾炎(气阴两虚型)患儿的临床分析

Clinical Efficacy of Modified Shenqi Dihuang Decoction(参芪地黄汤)in the Treatment of Children with Henoch-Schonlein Purpura Nephritis Due to Qiyinliangxu(气阴两虚)

目的:探讨参芪地黄汤加减对紫癜性肾炎(气阴两虚型)患儿的临床疗效及免疫学指标的影响。方法:84例患儿随机分为对照组和治疗组,每组42例,对照组予以口服卡托普利、泼尼松,治疗组在对照组基础上联合应用参芪地黄汤加减,疗程4 w。检测临床疗效、中医证候积分、尿红细胞数、尿蛋白水平、细胞免疫水平(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、体液免疫(IgA、IgG、IgM)水平、补体(补体C3、C4)水平、血清IL-4、IL-21、TGF-β含量及不良反应。结果:治疗组总有效率为92.86%,明显高于对照组的78.57%(P<0.05)。与治疗前比较,两组治疗后中医证候积分、尿红细胞数、尿蛋白水平、IgA、IgG、IgM、补体C3、C4水平、IL-4、IL-21、TGF-β含量、CD8^(+)T细胞水平均明显降低(P<0.05);CD4^(+)T细胞、CD4^(+)/CD8^(+)水平均明显升高(P<0.05);治疗后,治疗组中医证候积分、尿红细胞数、尿蛋白水平、IgA、IgG、IgM、补体C3、补体C4、IL-4、IL-21、TGF-β水平、CD8^(+)T细胞水平均明显低于对照组(P<0.05);治疗组CD4^(+)T细胞、CD4^(+)/CD8^(+)水平明显高于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:参芪地黄汤加减治疗儿童紫癜性肾炎(气阴两虚型)能提高临床疗效、纠正机体免疫失衡、减轻机体免疫损伤、延缓疾病进展,安全性良好。

Objective:To explore the clinical efficacy of modified Shenqi Dihuang Decoction(参芪地黄汤)in the treatment of children with Henoch-Schonlein purpura nephritis due to Qiyinliangxu(气阴两虚)and its effect on immunological indexes.Methods:Eighty-four children patients were randomly divided into a control group and a treatment group,with 42 cases in each group.The patients in the control group were treated with captopril and prednisone,while those in the treatment group were treated with modified Shenqi Dihuang Decoction on the basis of the therapeutic protocol of the control group.The course of treatment was four weeks.The clinical efficacy,syndrome score in traditional Chinese medicine(TCM),urine red blood cell count,urine protein level,cellular immunity levels(CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)),humoral immunity levels(IgA,IgG,and IgM),complement levels(complement C3 and C4),serum levels of IL-4,IL-21,and TCF-β,and adverse reactions were detected.Results:The total effective rate of the treatment group was higher than that of the control group(P<0.05).Compared with the results before treatment,the syndrome scores in TCM,urine red blood cell counts,urine protein levels,levels of IgA,IgG,IgM,complement C3,and C4,serum levels of IL-4,IL-21,and TGF-β,and CD8^(+)T cellular immunity levels in both groups were reduced after treatment(P<0.05),while the levels of CD4^(+)T cells and CD4t/CD8*increased(P<0.05).After treatment,compared with the control group,the treatment group showed lowered TCM Zhenghou score,urine red blood cell count,urine protein level,levels of IgA,IgG,IgM,complement C3 and C4,levels of IL-4,IL-21,and TCF-β,and CD8^(+)T cellular immunity level(P<0.05),and higher levels of CD4^(+)T cells and CD4^(+)/CD8^(+)(P<0.05).The incidence of adverse reactions showed no significant difference between the two groups.Conclusion:Modified Shenqi Dihuang Decoction can improve the clinical efficacy,correct the immune imbalance,reduce the immune injury,and delay the disease progression in the treatment of children with Henoch-Schonlein purpura nephritis children due to Qiyinliangxu.