刘晓鹰教授治疗儿童紫癜性肾炎血尿蛋白尿型临床经验

Professor LIU Xiaoying′s Clinical Experience in Treatment of Henoch-schonleinPurpura Nephritis in Children with Hematuria and Proteinuria

目的:探讨刘晓鹰教授治疗儿童紫癜性肾炎(HSPN)血尿蛋白尿型的临床用药经验,为临床诊治HSPN提供思路。方法:对既往接诊的HSPN血尿蛋白尿型,仅用中药治疗且疗效为临床缓解和显效的病例,收集处方建立数据库,运用SPSS 23.0统计软件、R语言、VOSviewer、Pajek软件分析药物频次、四气五味、归经以及药物规则。结果:纳入病例57例,处方955张,总药物309味,用药总频次15 584次。药物频次最高的前10位药物为甘草、茯苓、连翘、黄芪、赤芍、白术、紫草、漏芦、当归、茜草;药性以寒、凉为主,药味以甘、苦、辛为主,归经以肺、肝、胃、心、脾、肾为主;2味药物组合,提升度最高的为墨旱莲-女贞子;3味药物组合,提升度最高的为牡丹皮-紫草-赤芍;4味药物组合,提升度最高的为牡丹皮-地黄-赤芍-紫草。结论:在治疗HSPN时,抓住其“肺热、血瘀、脾虚”的主要病机特点,选用清肺热、清热凉血止血、活血化瘀、补中益气的中药对疾病进行分期辨证治疗。

Objective:To explore Professor LIU Xiaoying′s clinical experience with the use of drugs in the treatment of Henoch-schonlein purpura nephritis(HSPN)in children with hematuria and proteinuria and provide ideas for the clinical diagnosis and treatment of HSPN.Methods:For the HSPN cases with hematuria and proteinuria admitted to the hospital and treated with traditional Chinese medicine(TCM)only,the cases with clinical remission and obvious effect were collected,and a database of corresponding prescriptions was established.SPSS 23.0 software,R language,VOSviewer,and Pajek software were used to analyze drug frequency,four properties and five tastes,channel normalization,and drug rules.Results:A total of 57 cases were included,with 955 prescriptions,309 drugs,and 15584 frequency of medication.The top ten most frequently prescribed drugs were Radix et Rhizoma Glycyrrhizae,Poria,Fructus Forsythiae,Radix Astragali,Radix Paeoniae Rubra,Rhizoma Atractylodis Macrocephalae,Radix Arnebiae,Radix Rhapontied,Radix Angelicae Sinensis,and Radix Rubiae.The properties of the drug are cold and cool,and the tastes are sweet,bitter,and astringent.The channels are the lungs,liver,stomach,heart,spleen,and kidneys,which are successively reduced in frequency.For the combinations of two drugs,the drug pair with the highest improvement was Myrtaceae and Fructus ligustris.For the combinations of three drugs,the highest improvement was Cortex Moutan,Radix Arnebiae,and Radix Paeoniae Rubra.For the combinations of four drugs,the highest improvement was achieved by Cortex Moutan,Radix Rehmanniae Recens,Radix Paeoniae Rubra,and Radix Arnebiae.Conclusion:In the treatment of HSPN,Professor LIU Xiaoying grasped the main pathogenesis characteristics of“lung heat,blood stasis,and spleen deficiency”and selected the TCM of clearing lung heat,cooling blood and hemostasis,promoting blood stasis,strengthening the middle-jiao,and benefiting vital energy for stage differentiation and treatment.