Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children

Xiao-shi ZHU; Yu ZHANG; Jun-chao DENG; Yun-bi LI; Jian-chao LI

doi:10.13422/j.cnki.syfjx.20200332

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Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children

Clinic | 更新时间：2020-09-09

- Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children
- Chinese Journal of Experimental Traditional Medical Formulae Vol. 26, Issue 17, Pages: 89-94(2020)
- 作者机构：
  
  四川省医学科学院，四川省人民医院，成都 610072
- 作者简介：
- 基金信息：
- DOI：10.13422/j.cnki.syfjx.20200332
  CLC： R289;R272;R692;R692.3+4
- Published Online：07 December 2019，
  
  Published：05 September 2020
- 稿件说明：
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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.

ZHU Xiao-shi,ZHANG Yu,DENG Jun-chao,et al.Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(17):89-94.
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. DOI： 10.13422/j.cnki.syfjx.20200332.

ZHU Xiao-shi,ZHANG Yu,DENG Jun-chao,et al.Clinical Efficacy of Modified Zhibo Dihuangwan in Treatment of Purpura Nephritis with Deficiency of Liver and Kidney Yin in Children[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(17):89-94. DOI： 10.13422/j.cnki.syfjx.20200332.

摘要

目的

观察知柏地黄丸加减治疗小儿紫癜性肾炎(HSPN) 肝肾阴虚证的疗效及对免疫炎症反应和高凝状态的影响。

方法

将120例符合要求的患儿按随机数字表法分为观察组和对照组各60例。对照组采用醋酸泼尼松龙片，1.5～2 mg·kg

-1

·d

-1

，分2次口服，4周后逐渐减量，改为隔日口服；注射用环磷酰胺，8～12 mg·kg

-1

·d

-1

，连续2 d静脉滴注，停2周，再行下1个疗程，共6个月。对照组口服大补阴丸，3 g/次，3次/d；观察组采用知柏地黄丸加减内服，1剂/d。连续治疗6个月。每月检测1次尿常规，记录血尿和蛋白尿消失时间和消失率，评价治疗前后24 h尿蛋白定量、尿微量白蛋白（mAlb）和尿

微球蛋白（

-MG）水平。进行治疗前后肝肾阴虚证评分；检测治疗前后T 淋巴细胞亚群（CD3

，CD4

，CD8

，CD4

/CD8

），纤维蛋白原(FIB)，

-二聚体(

-D)，纤维蛋白降解产物(FDP)，白细胞介素-2（IL-2），IL-4，IL-10和干扰素-

（IFN-

）水平。

结果

观察组患儿临床疗效优于对照组（

=2.078，

0.05）；观察组患儿血尿消失时间和蛋白尿消失时间均短于对照组（

0.01）；观察组蛋白尿消失率为90.48%（38/42），高于对照组的69.77%（30/43）（

＝5.694，

0.05）；观察组患儿24 h尿蛋白定量，mAlb和

-MG均低于对照组（

0.01）；观察组患儿CD3

，CD4

水平和CD4

/CD8

均高于对照组（

0.05），CD8

低于对照组（

0.05）；观察组患儿治疗后FIB，

-D和FDP均低于对照组（

0.01）；观察组患儿IL-2，IFN-

水平均高于对照组（

0.05），IL-4，IL-10水平均低于对照组（

0.05）；观察组患儿中医证候疗效好于对照组（

=2.106，

0.05）。

结论

在西医常规治疗的基础上，采用知柏地黄丸加减内服治疗HSPN肝肾阴虚证患儿，可促进蛋白尿和血尿的消失，缩短了病程，并可改善Ｔ淋巴细胞亚群，减轻炎症反应，纠正血液高凝状态，很好地提高临床疗效和中医证候疗效。

Abstract

Objective

To observe the clinical efficacy of modified Zhibo Dihuangwan on henoch-schonlein purpura nephritis with deficiency of liver and kidney yin in children (HSPN) and its effect on immune inflammatory response and hypercoagulable state.

Method

Totally 120 patients were randomly divided into observation group (60 cases) and control group (60 cases) by random number table. Patients in two group was orally given prednisolone acetate tablets

1.5-2 mg·kg

-1

·d

-1

2 times. Four weeks later

the drug was taken orally every other day

and the dosage decreased gradually after 4 weeks. Besides

patients in control group was intravenously dripped with cyclophosphamide

8-12 mg·kg

-1

·d

-1

for 2 days

and stopped for 2 weeks before another treatment course. The treatment lasted for 6 months. In the control group

Dabuyin Wan was taken orally

3 g/time

3 times/d.Patients in observation group was also added with modified Zhibo Dihuang Wan

1 doe/day. The treatment lasted for 6 months. Urine routine was tested once a month

and disappearance time and rate of hematuria and albuminuria were recorded. The 24 h urine protein quantification

levels of microalbuminuria (mAlb) and urinary

-microglobulin (

-MG) were assessed before and after treatment. Furthermore

deficiency of liver and kidney Yin was scored

and levels of T lymphocyte subsets (CD3

CD4

CD8

CD4

/CD8

)

fibrinogen (FIB)

-dimer (

-D)

fibrin degradation products (FDP)

interleukin-2 (IL-2)

interferon-

(IFN-

)

interleukin-4 (IL-4)

interleukin-10 (IL-10) were detected.

Result

The clinical efficacy in observation group was superior to that in control group (

=2.078，

0.05). Disappearance times of hematuria and albuminuria of children in observation group were shorter than those in control group (

0.01). The disappearance rate of proteinuria in observation group was 90.48%（38/42）

which was higher than 69.77%（30/43） in control group (

=5.694，

0.05). The 24 h urinary protein quantity

mAlb and levels of

-MG

FIB

D-D and FDP in observation group were lower than those in control group (

0.01). The levels of CD3

CD4

IL-2 and IFN-

and the ratio of CD4

/CD8

in observation group were higher than those in control group (

0.05)

while the CD8

IL-4 and IL-10 were lower than those in control group (

0.05). The efficacy in observation group was better than that in control group (

=2.106，

0.05).

Conclusion

In addition to conventional western medicine therapy

modified Zhibo Dihuang Wan have an effect on HSPN with deficiency of liver and kidney Yin in children by promoting the disappearance of albuminuria and hematuria

shortening the course of disease

improving T lymphocyte subpopulation

reducing inflammatory reaction and correcting hypercoagulable state of blood

with better clinical efficacy and syndrome effect of traditional Chinese medicine.

关键词

Keywords

references

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