ISSN 1674-3865  CN 21-1569/R
主管:国家卫生健康委员会
主办:中国医师协会
   辽宁省基础医学研究所
   辽宁中医药大学附属医院

中国中西医结合儿科学 ›› 2019, Vol. 11 ›› Issue (1): 54-58.doi: 10.3969/j.issn.1674-3865.2019.01.015

• 临床研究 • 上一篇    下一篇

温阳补肾法治疗儿童原发性难治性肾病综合征的疗效观察

魏磊,刘翠华   

  1. 450018 郑州,郑州大学附属儿童医院、河南省儿童医院、郑州儿童医院肾脏风湿科
  • 出版日期:2019-02-25 发布日期:2019-07-11
  • 通讯作者: 魏磊,E-mail:ceoleilei@163.com
  • 作者简介:魏磊(1981-),女,医学硕士,主治医师。研究方向:小儿肾脏风湿疾病的诊治

Clinical study on Wenyang Bushen method in the treatment of primary refractory nephrotic syndrome in children

WEI Lei,LIU Cuihua   

  1. Department of Kidney and Rheumatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450018, China
  • Online:2019-02-25 Published:2019-07-11

摘要:
目的
探讨温阳补肾法治疗儿童原发性难治性肾病综合征(RNS)的临床研究。
方法
选择2015年1月至2016年12月郑州儿童医院收治的RNS患儿68例,随机分为观察组和对照组各34例。两组均给予常规对症治疗,对照组给予促皮质素+泼尼松治疗,观察组在对照组治疗基础上给予温阳补肾汤治疗,连续治疗24周。观察两组临床疗效及中医症状积分、血清生化指标(甘油三酯、胆固醇、尿素氮、血肌酐、皮质醇)、T淋巴细胞水平(CD3+、CD4+、CD8+、CD4+/CD8+值)、不良反应和随访1年的复发情况。
结果
(1)治疗后观察组总有效率为88.24%(30/34),显著高于对照组67.65%(23/34),差异有统计学意义(P<0.05)。(2)治疗后两组患者的面浮肢肿、小便不利、气短乏力、神萎纳差积分显著低于治疗前,观察组积分显著低于对照组,差异有统计学意义(P<0.05)。(3)治疗后两组血清甘油三酯、胆固醇、尿素氮、血肌酐水平显著低于治疗前,观察组显著低于对照组,差异有统计学意义(P<0.05)。治疗后两组血清皮质醇水平显著高于治疗前,观察组显著高于对照组,差异有统计学意义(P<0.05)。(4)治疗后两组CD3+、CD4+及CD4+/CD8+值显著高于治疗前,观察组显著高于对照组,差异有统计学意义(P<0.05);治疗后两组CD8+显著低于治疗前,观察组显著低于对照组,差异有统计学意义(P<0.05)。(5)两组患者不良反应发生率比较差异无统计学意义(P>0.05);观察组1年平均复发次数显著少于对照组,复发率显著低于对照组,差异有统计学意义(P<0.05)。
结论
温阳补肾法治疗小儿RNS疗效显著,可明显改善患儿相关症状,有效改善脂质代谢紊乱,减轻肾损伤,调节其免疫系统功能,降低病情复发风险,可安全应用于临床中。

关键词: 原发性难治性肾病综合征, 温阳补肾法, 儿童

Abstract:
Objective
To discuss the clinical study on Wenyang Bushen method in the treatment of children with primary refractory nephrotic syndrome(RNS).
Methods
Totally 68 child patients with RNS treated in Zhengzhou Children's Hospital between January 2015 and December 2016 were selected and randomly divided into observation group and control group, with 34 cases in each group. The two groups were given routine symptomatic treatment. Both groups were given corticotropin+prednisone, and observation group was additionally treated by Wenyang Bushen method. The treatment lasted for 24 weeks. The clinical efficacy, TCM symptom scores, serum biochemical indicators (triglyceride, cholesterol, urea nitrogen, serum creatinine, cortisol), T lymphocytes levels(CD3+, CD4+, CD8+, CD4+/CD8+), adverse reactions and recurrence at 1 year of followup were observed in the two groups.
Results
The total effective rate in observation group after treatment was significantly higher than that in control group [88.24% (30/34) vs 67.65% (23/34)] (P<0.05). After treatment, the scores of puffy face and swollen limbs, difficult urination, shortness of breath and fatigue and poor appetite in the two groups were significantly lower than those before treatment, and the scores in observation group were significantly lower than those in control group (P<0.05). The levels of serum triglyceride, cholesterol, serum urea nitrogen and serum creatinine after treatment in the two groups were significantly lower than those before treatment, and the levels in observation group were significantly lower than those in control group (P<0.05). The serum cortisol level after treatment in the two groups was significantly higher than that before treatment, and the level in observation group was significantly higher than that in control group(P<0.05). After treatment, the CD3+ and CD4+ and CD4+/CD8+ in the two groups were significantly higher than those before treatment, and the indexes in observation group were significantly higher than those in control group (P<0.05). After treatment, the CD8+ in the two groups was significantly lower than that before treatment, and the index in observation group was significantly lower than that in control group (P<0.05). There was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05). The average frequency of recurrence within 1 year in observation group was significantly less than that in control group (P<0.05), and the recurrence rate was significantly lower than that in control group (P<0.05).
Conclusion
Wenyang Bushen method combined with corticotropin has significant efficacy on children with RNS, and it can significantly improve the related symptoms, effectively improve lipid metabolism disorders, reduce kidney damage, regulate immune system function, and reduce the risk of recurrence, so it can be safely applied in clinical practice.

Key words: Primary refractory nephrotic syndrome, Wenyang Bushen method, Children