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1.成都中医药大学,成都 610075
2.重庆市中医院,重庆 400021
3.重庆市江北区中医院,重庆 400020
4.重庆市綦江区中医院,重庆 401420
Published:20 September 2023,
Published Online:20 July 2023,
Received:16 January 2023,
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郑珊,文仲渝,秦耘等.尿血1号方治疗儿童血热夹瘀型过敏性紫癜肾炎的临床疗效[J].中国实验方剂学杂志,2023,29(18):87-94.
ZHENG Shan,WEN Zhongyu,QIN Yun,et al.Clinical Efficacy of Niaoxue No.1 Prescription in Treatment of Henoch-Schönlein Purpura Nephritis with Blood Heat and Stasis Syndrome in Children[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(18):87-94.
郑珊,文仲渝,秦耘等.尿血1号方治疗儿童血热夹瘀型过敏性紫癜肾炎的临床疗效[J].中国实验方剂学杂志,2023,29(18):87-94. DOI: 10.13422/j.cnki.syfjx.20240391.
ZHENG Shan,WEN Zhongyu,QIN Yun,et al.Clinical Efficacy of Niaoxue No.1 Prescription in Treatment of Henoch-Schönlein Purpura Nephritis with Blood Heat and Stasis Syndrome in Children[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(18):87-94. DOI: 10.13422/j.cnki.syfjx.20240391.
目的
2
探讨尿血1号方治疗血热夹瘀证过敏性紫癜肾炎的临床疗效及对尿红细胞、尿蛋白、血中性粒细胞和血常规衍生指标的影响。
方法
2
采用多中心,随机对照试验方法,将3家医院108例过敏性紫癜肾炎患儿,随机数字表法分为对照组和观察组,每组各54例。观察组予尿血1号方治疗,每日1剂;对照组予卡托普利及阿魏酸片治疗。两组疗程均为4周。监测尿镜检红细胞、尿微量白蛋白、尿沉渣红细胞计数、中医证候积分、24 h尿蛋白、血中性粒细胞比率、中性粒细胞/淋巴细胞(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)、
D
-二聚体、免疫球蛋白A(IgA),随访6个月后紫癜肾炎复发率。
结果
2
观察组疾病总有效率为88.9%(48/54),对照组为70.4%(38/54),观察组优于对照组,差异具有统计学意义(
χ
2
=5.708,
P
<
0.05)。与本组治疗前比较,治疗第14天,观察组患儿中医证候总积分、尿镜检红细胞、尿微量白蛋白、24 h尿蛋白均明显降低(
P
<
0.05,
P
<
0.01),与对照组治疗后比较,观察组中医证候总积分、尿镜检红细胞、尿微量白蛋白、24 h尿蛋白改善更明显(
P
<
0.05)。与本组治疗前比较,治疗第28天,两组患儿中医证候积分、尿镜检红细胞、尿微量白蛋白、尿沉渣红细胞计数、
D
-二聚体及24 h尿蛋白均明显降低(
P
<
0.05,
P
<
0.01),与对照组治疗后比较,其中观察组尿微量白蛋白明显降低(
P
<
0.05)。观察组在第14天和第28天时,中性粒细胞比率、NLR均低于对照组(
P
<
0.05),但PLR、LMR差异无统计学意义。随访6个月后两组患儿肾炎复发率差异无统计学意义。
结论
2
采用尿血1号方治疗血热夹瘀型紫癜肾炎,可显著改善临床症状,缩短病程。降低紫癜肾炎患儿尿红细胞、尿微量白蛋白、24 h尿蛋白、中性粒细胞及NLR,有效减轻肾脏的炎症状态,减轻肾脏损伤。
Objective
2
To investigate the clinical efficacy of Niaoxue No.1 Prescription in treating Henoch-Schönlein purpura (HSP) nephritis with blood heat and stasis syndrome and its effect on urine erythrocyte, urine protein, blood neutrophils, and blood routine-derived indicators.
Method
2
A multicenter, randomized controlled trial (RCT) was conducted involving 108 HSP nephritis patients from three hospitals. The patients were randomly divided into a control group (54 cases) and a treatment group (54 cases). The treatment group received Niaoxue No.1 prescription once daily, while the control group was treated with captopril and ferulic acid tablets. Both groups underwent a 4-week course of treatment. The urine erythrocyte, urine microalbumin (mAlb), urine sediment red blood cell count, traditional Chinese medicine (TCM) syndrome score, 24-hour urine protein, blood neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR),
D
-dimer, and immunoglobulin A were detected. The recurrence rate of HSP nephritis was followed up for 6 months.
Result
2
The total effective rates were 88.9% (48/54) in the treatment group and 70.4% (38/54) in the control group, and the treatment group was superior to the control group (
χ
2
=5.708,
P
<
0.05). Compared with the results before treatment, after 14 days of treatment, the TCM syndrome total score, urine erythrocyte, urine mAlb, and 24-hour urine protein in both groups significantly decreased (
P
<
0.05,
P
<
0.01), and the improvement was more significant in the treatment group than the control group (
P
<
0.05). After 28 days of treatment, compared with the results before treatment, the TCM syndrome total score, urine erythrocyte, urine mAlb, urine sediment red blood cell count,
D
-dimer, and 24-hour urine protein in both groups significantly decreased (
P
<
0.05,
P
<
0.01), with the treatment group showing a more significant reduction in urine mAlb than the control group (
P
<
0.05). On the 14
th
and 28
th
days of treatment, the neutrophil percentage and NLR were lower in the treatment group than in the control group (
P
<
0.05), while there was no statistically significant difference in PLR and LMR. The recurrence rate of nephritis in both groups showed no statistically significant difference after a 6-month follow-up.
Conclusion
2
Niaoxue No.1 Prescription in the treatment of HSP nephritis with blood heat and stasis syndrome can significantly improve clinical symptoms, shorten the course of the disease, and reduce urine erythrocyte, urine mAlb, 24-hour urine protein, blood neutrophils, and NLR, thereby effectively alleviating the inflammatory state and reducing kidney damage in children with HSP nephritis.
过敏性紫癜肾炎中性粒细胞血热夹瘀证
Henoch-Schönlein purpuranephritisneutrophilsyndrome of blood heat and blood stasis
CHARTAPISAK W,OPASTIRAKU S,WILLIS N S,et al. Prevention and treatment of real disease in Henoch- Schönlein purpura:A systematic review[J].Arch Dis Child,2009,94(2):132-137.
NICOLINA S C,GIULIA L B,LICIA P,et al. Time of onset and risk factors of renal involvement in children with Henoch-Schönlein purpura:Retrospective study[J]. Children (Basel) 2022 ,9(9):1394.
LI Y X,YONG Z L,XIAO C W,et al.IgA vasculitis update: Epidemiology, pathogenesis,and biomarkers[J].Front Immunol. 2022 ,10 (3):921864.
CHEN J Y, MAO J H. Henoch-Schönlein purpura nephritis in children:Incidence, pathogenesis and management[J]. World J Pediatr ,2015,11(1):29-34.
MAO Y,YIN L,HUANG H,et al. Henoch-Schönlein purpura in 535 Chinese children:Clinical features and risk factors for renal involvement[J].J Int Med Res,2014,42(4):1043-1049.
WANG M,WANG R,He X,et al. Using MEST-c scores and the international study of kidney disease in children classification to predict outcomes of Henoch-Schönlein purpura nephritis in children[J]. Front Pediatr,2021,9:658845.
CHEN A C,LIN C L,SHEN T C,et al. Association between allergic diseases and risks of HSP and HSP nephritis:A population-based study[J]. Pediatr Res,2016,79(4):559-564.
全国儿童常见肾脏病诊治现状调研工作组.儿童紫癜性肾炎诊治现状多中性回顾性调查分析[J].中华儿科杂志,2013,51(12):881-887.
吴小平.儿童过敏性紫癜的诊疗进展[J].中华实用儿科临床杂志,2013,28(21):1605-1608.
杨霁云.小儿过敏性紫癜肾炎诊治中的几个问题[J].肾脏病与透析肾移植杂志,2004,13(2):147-149.
施蕾,庞礴,许琳洁,等.中医药治疗儿童过敏性紫癜性肾炎的研究进展[J]. 中华中医药杂志,2019,34(2):708-710.
丁东辉,张文静,喇登海.中医药治疗过敏性紫癜性肾炎的研究进展[J].中国民族民间医药,2021,30(19):65-68.
赵骞,何松蔚,何强. 基于数据挖掘研究闫慧敏治疗小儿过敏性紫癜性肾炎用药规律[J].北京中医药,2021,40(8):907-910.
徐雅楠,王圣治. 从卫气营血辨治过敏性紫癜性肾炎探析[J].中医药临床杂志,2021,33(12):2270-2273.
王艳秋,孟翔鹤,秦静波,等.基于Cite space的中医药治疗过敏性紫癜可视化分析[J].中国实验方剂学杂志,2020,26(10):173-179.
张玲,常克,孙香娟.尿血1号方促肾小球系膜细胞凋亡的实验研究[J].中医儿科杂志,2011,7(1):13-15.
HAN F,CHEN LL,REN P P,et al. Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis:A retrospective study[J].J Zhejiang Univ Sci B,2015,16(9):772-779.
中华医学会儿科学分会肾脏学组.紫癜性肾炎诊治循证指南(2016)[J].中华儿科杂志,2017,55(9):647-651.
易著文.小儿过敏性紫癜的诊断与治疗[J].中国实用儿科杂志. 2009,24(11):827-829.
中华中医药学会.中医儿科常见病诊疗指南[M].北京:中国中医药出版社,2012:175-176.
FOX M,CARTER S,KHOURI I F,et al. Adult Henoch-Schönlein purpura in a patient with myelodysplastic syndrome and a history of follicular lymphoma[J]. Cutis,2008,81(2):131 -137.
郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:162.
张爱华,朱春华.儿童紫癜性肾炎治疗进展[J].中华实用儿科临床杂志,2017,32(5):324-327.
袁振华,任献青,丁樱,等. 儿童过敏性紫癜性肾炎从“伏毒损络”论治探微[J].中国中医基础医学杂志,2022,28(9):1524-1527.
陈彦霖,张颖煜,沈佳丽,等. 国医大师邹燕勤从瘀论治过敏性紫癜性肾炎经验撷要[J].湖南中医药大学学报,2021,41(5):664-667.
赵骞,何强,何松蔚. 闫慧敏从络病论治儿童过敏性紫癜性肾炎经验[J].辽宁中医杂志,2020,47(12):48-50.
张李博,任雄飞,郭婷婷 ,等. 孙郁芝治疗过敏性紫癜性肾炎经验[J].时珍国医国药,2021,32(10):3-4.
袁婷婷,张锐锋. 槐杞黄颗粒治疗过敏性紫癜性肾炎患儿疗效及对肾功能及免疫炎性因子的影响[J].现代中西医结合杂志,2020,29(5):545-548.
董建华,王祖亮,夏永光,等. 紫癜汤加减对儿童紫癜性肾炎免疫炎症因子的调节作用[J].中国实验方剂学杂志,2021,27(2):104-109.
朱小石,张渝,邓俊超,等. 知柏地黄丸加减治疗小儿紫癜性肾炎肝肾阴虚证的疗效观察[J].中国实验方剂学杂志,2020,26(17):89-94.
卢积坪,李红毅,党若楠,等. 禤国维教授治疗儿童过敏性紫癜性肾炎经验[J]. 中国医药导报,2019,16(36):149-152.
LIYUN X,YONG Z L,XIAO C W. IgA vasculitis update:Epidemiology,pathogenesis,and biomarkers[J]. Front Immunol, 2022,3(13):921864.
BREEDVELD A,VAN EGMOND M. IgA and FcαRI:Pathological roles and therapeutic opportunities[J]. Frontiers Immunology,2019,6(3):553-573 .
李小平,赵位昆,申小平,等.过敏性紫癜患儿发生紫癜性肾炎的危险因素及NLR、PLR变化分析[J].内科,2020,15(4):387-395.
EKINCI RMK,BALCI S,SARI GOKAY S,et al. Do practical laboratory indices predict the outcomes of children with Henoch-Schönlein purpura?[J]. Postgrad Med,2019,131(4):295 -298.
吴敏,南虎松.LMR和NLR对儿童过敏性紫癜肾损伤的临床诊断价值[J].吉林医学,2018,39(10) :1873-1876.
GEZA RN,LAJOS K,ZSUZSANNA BC.Neutrophil-to-lymphocyte ratio:A biomarker for predicting systemic involvement in adult IgA vasculitis patients[J]. J Eur Acad Dermatol Venereol,2017,31(6):1033-1037.
张国娟,黄雯,陈燊.中性粒细胞淋巴细胞比值在评价慢性肾脏病患者炎症状态中的作用[J].中国血液净化,2015,14(8):482-485.
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