加味防己黄芪汤辅助治疗儿童原发性肾病综合征肺脾气虚证50例临床观察

Clinical observation on 50 cases of lung-spleen qi deficiency syndrome in children of primary nephrotic syndrome adjuvantly treated with modified Fangji Huangqi Tang(防己黄芪汤)

目的观察加味防己黄芪汤联合西医治疗儿童原发性肾病综合征(PNS)肺脾气虚证的临床疗效。方法选取2019年1月至2021年1月在中国人民解放军东部战区总医院儿科住院部治疗的PNS肺脾气虚证患儿100例,采用随机数字表法分为治疗组和对照组,各50例。对照组予醋酸泼尼松片口服和低分子肝素钠注射剂皮下注射,治疗组在对照组治疗方法的基础上联合加味防己黄芪汤。2组均治疗4周后统计临床疗效,比较2组治疗前后血浆白蛋白(ALB)、总胆固醇(TC)、甘油三酯(TG)、血小板计数(PLT)、血浆纤维蛋白原(FIB)、D-二聚体、活化部分凝血活酶时间测定(APTT)、T淋巴细胞免疫功能CD4^(+)、CD8^(+)、CD4/CD8以及24 h尿蛋白定量等指标。结果治疗组总有效率为92.0%(46/50),显著高于对照组的78.0%(39/50),2组比较,差异有统计学意义(P<0.05)。治疗前2组ALB、TC、TG以及24 h尿蛋白定量值比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组ALB显著升高,TC、TG以及24 h尿蛋白定量显著降低,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组升高或降低更显著(P<0.05)。治疗前2组PLT、FIB、APTT和D-二聚体比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组PLT、FIB、D-二聚体显著降低,APTT显著升高,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组降低或升高更显著(P<0.05)。治疗前2组CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组CD4^(+)、CD4^(+)/CD8^(+)显著升高,CD8^(+)显著降低,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组升高或降低更显著(P<0.05)。治疗前2组中医证候评分比较,差异无统计学意义(P>0.05),具有可比性;治疗后2组中医证候评分显著降低,与同组治疗前比较,差异有统计学意义(P<0.05),且治疗组降低更显著(P<0.05)。结论加味防己黄芪汤辅助治疗PNS肺脾气虚证疗效满意,可显著降低中医证候评分、尿蛋白定量和血脂水平,改善凝血功能,并可提高患儿的免疫功能,值得临床推广应用。

Objective eTo observe the clinical efficacy of modified Fangji Huangqi Tang(防己黄芪汤)com-bined with Western medicine in the treatment of children with primary nephrotic syndrome(PNS)of lung-spleen qi deficiency syndrome.Methods From January 2019 to January 2021,100 children of PNS with lung-qi deficiency syndrome were selected and divided into a treatment group and a control group by random number table method,with 50 cases in each group.The control group was given oral prednisone acetate tablet and subcutaneous injection of low molecular weight heparin sodium,and the treatment group was combined with modified Fangji Huangqi Tang based on the treatment method of the control group.After 4 weeks of treatment,the clinical efficacy of both groups was statistically analyzed.The plasma albumin(ALB),total cholesterol(TC),triglycerides(TG),platelet count(PLT),plasma fibrinogen(FIB),D-dimer,activated partial thromboplastin time(APTT),CD4^(+),CD8^(+),CD4/CD8 ratio of T lymphocyte immune function,and 24-hour urine protein quantification were compared between the two groups before and after treatment.Results The total effective rate of the treatment group was 92.0%(46/50),sig-nificantly higher than the control group's 78.0%(39/50),and the difference between the two groups was statisti-cally significant(P<0.05).There was no statistically significant difference(P>0.05)in the quantitative values of ALB,TC,TG,and 24-hour urine protein between the two groups before treatment,indicating comparability.After treatment,ALB significantly increased in both groups,while TC,TG,and 24-hour urine protein quantification signif-icantly decreased.Compared with the same group before treatment,the difference was statistically significant(P<0.05),and the increase/decrease in the treatment group was more significant(P<0.05).There was no statistically significant difference(P>0.05)in PLT,FIB,APTT,and D-dimer between the two groups before treatment,indica-ting comparability.Afier treatment,PLT,FIB,D-dimer significantly decreased and APTT significantly increased in the two groups.Compared with the same group before treatment,the difference was statistically significant(P<0.05),and the decrease/increase in the treatment group was more significant(P<0.05).The comparison of CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)ratios between the two groups before treatment showed no statistically significant diference(P>0.05),indicating comparability.After treatment,the CD4^(+)and CD4^(+)/CD8^(+)ratios in the two groups significantly increased,while CD8 significantly decreased.Compared with the same group before treatment,the difference was statistically significant(P<0.05),and the increase/decrease in the treatment group was more signifi-cant(P<0.05).The comparison of TCM syndrome scores between the two groups before treatment showed no statis-tically significant difference(P>0.05),indicating comparability.After treatment,the TCM syndrome scores of the two groups significantly decreased,with a statistically significant difference compared to before treatment in the same group(P<0.05),and the treatment group showed a more significant decrease(P<0.05).Conclusion Modified Fangji Huangqi Tang has satisfactory effect in the adjuvant treatment of PNS with lung-spleen qi deficiency syndrome,which can significantly reduce TCM syndrome score,urinary protein quantity and lipid level,improve coagulation function and immune function of children,and is worthy of clinical application.