Volume 39 Issue 7
Jul.  2023
Turn off MathJax
Article Contents
NI Jin-yu, ZHANG Meng-meng, REN Xiang-ge, ZHANG Qiu-yue, LI Bing, YANG Meng, ZHANG Jian, ZHAI Wen-sheng. Clinical Study of Traditional Chinese Medicine Combined with Hormone Non-Tailing Therapy in the Treatment of Children with Refractory Nephrotic Syndrome[J]. Journal of Nanjing University of traditional Chinese Medicine, 2023, 39(7): 669-676. doi: 10.14148/j.issn.1672-0482.2023.0669
Citation: NI Jin-yu, ZHANG Meng-meng, REN Xiang-ge, ZHANG Qiu-yue, LI Bing, YANG Meng, ZHANG Jian, ZHAI Wen-sheng. Clinical Study of Traditional Chinese Medicine Combined with Hormone Non-Tailing Therapy in the Treatment of Children with Refractory Nephrotic Syndrome[J]. Journal of Nanjing University of traditional Chinese Medicine, 2023, 39(7): 669-676. doi: 10.14148/j.issn.1672-0482.2023.0669

Clinical Study of Traditional Chinese Medicine Combined with Hormone Non-Tailing Therapy in the Treatment of Children with Refractory Nephrotic Syndrome

doi: 10.14148/j.issn.1672-0482.2023.0669
  • Received Date: 2023-04-14
    Available Online: 2023-07-15
  •   OBJECTIVE  To evaluate the clinical efficacy of traditional Chinese medicine combined with hormone non-tailing therapy in the treatment of children with refractory nephrotic syndrome (RNS).  METHODS  A total of 122 children with RNS who were treated in the hospital from June 2019 to June 2022 were divided into an observation group and a control group according to the random number table method, with 60 cases in the observation group and 62 cases in the control group.The control group was given prednisone tablets combined with tacrolimus treatment, of which prednisone tablets were treated with tailing therapy.On the basis of the control group, the observation group was additionally treated with traditional Chinese medicine (sequential syndrome differentiation of Yiqi Huayu Qingre Decoction), among which the prednisone tablets were treated with non-tailing therapy.To compare the total cumulative amount of hormones, hormone side effects, total effective rate and recurrence rate after 52 weeks of treatment.The changes of 24 h urine protein quantification (24 h UTP), plasma albumin (ALB), and blood lipids[total cholesterol (TC) and triglyceride (TG)]before treatment and after 4 weeks, 12 weeks and 24 weeks of treatment were compared.The changes of liver and kidney function, i.e., alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (SCr) before treatment and after 24 weeks of treatment were compared.Observe the changes in the scores of the Chinese medicine life quality evaluation scale in children with refractory nephropathy before treatment and after 24 weeks of treatment.  RESULTS  After 4 weeks, 12 weeks and 24 weeks of treatment, 24 h UTP, ALB, TC and TG in the two groups were improved compared with those before treatment, and the improvement in the observation group was more obvious (P < 0.05, P < 0.01).There was no significant change in ALT, AST, BUN and SCr in the two groups before and after 24 weeks of treatment (P>0.05).After 24 weeks of treatment, the scores of TCM syndromes in the two groups were significantly decreased (P < 0.05, P < 0.01), and the total scores of TCM quality of life scale were significantly increased (P < 0.01), and the observation group was better than the control group (P < 0.05, P < 0.01).After 52 weeks of treatment, the total cumulative amount of hormones in the observation group was lower than that in the control group (P < 0.01), and the side effects of hormones were less than those in the control group (P < 0.01).The total effective rate was higher than that of the control group (P < 0.05), and the recurrence rate was lower than that of the control group (P < 0.05).  CONCLUSION  Traditional Chinese medicine combined with hormone non-tailing therapy is effective in the treatment of children with RNS.It can increase plasma albumin, reduce the urine protein, and blood lipids, and improve the life quality of RNS children.

     

  • loading
  • [1]
    NOONE DG, ⅡJIMA K, PAREKH R. Idiopathic nephrotic syndrome in children[J]. Lancet, 2018, 392(10141): 61-74. doi: 10.1016/S0140-6736(18)30536-1
    [2]
    中华医学会儿科学分会肾脏学组. 儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(10): 729-734.

    Nephrology Group of Pediatrics Branch of Chinese Medical Association. Evidence-based guidelines for the diagnosis and treatment of steroid-sensitive, relapsed/dependent nephrotic syndrome in children(2016)[J]. Chin J Pediatr, 2017, 55(10): 729-734.
    [3]
    中华医学会儿科学分会肾脏学组. 激素耐药型肾病综合征诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(11): 805-809. doi: 10.3760/cma.j.issn.0578-1310.2017.11.002

    Nephrology Group of Pediatrics Branch of Chinese Medical Association. Evidence-based guidelines for the diagnosis and treatment of steroid-resistant nephrotic syndrome (2016)[J]. Chin J Pediatr, 2017, 55(11): 805-809. doi: 10.3760/cma.j.issn.0578-1310.2017.11.002
    [4]
    全国儿童常见肾脏病诊治现状调研工作组. 我国儿童激素敏感、复发/依赖肾病综合征诊疗现状的多中心研究[J]. 中华儿科杂志, 2014, 52(3): 194-200.

    National Working Group on Diagnosis and Treatment of Common Kidney Diseases in Children. A multicenter study on the diagnosis and treatment of steroid-sensitive, relapsed/dependent nephrotic syndrome in children in China[J]. Chin J Pediatr, 2014, 52(3): 194-200.
    [5]
    蒋小云. 我国儿童激素敏感、复发/依赖肾病综合征诊疗现状的多中心研究[J]. 中华儿科杂志, 2014, 52(3): 194-200.

    JIANG XY. A multicenter study on the diagnosis and treatment of steroid-sensitive, relapsed/dependent nephrotic syndrome in children in China[J]. Chin J Pediatr, 2014, 52(3): 194-200.
    [6]
    BANH TH, HUSSAIN-SHAMSY N, PATEL V, et al. Ethnic differences in incidence and outcomes of childhood nephrotic syndrome[J]. Clin J Am Soc Nephrol, 2016, 11(10): 1760-1768. doi: 10.2215/CJN.00380116
    [7]
    HJORTEN R, ANWAR Z, REIDY KJ. Long-term outcomes of childhood onset nephrotic syndrome[J]. Front Pediatr, 2016, 4: 53.
    [8]
    中华医学会儿科学分会肾脏病学组. 小儿肾小球疾病的临床分类、诊断及治疗[J]. 中华儿科杂志, 2001, 39(12): 45-48. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHEK200112019.htm

    Nephrology Group of Pediatrics Branch of Chinese Medical Association. Clinical classification, diagnosis and treatment of glomerular diseases in children[J]. Chin J Pediatr, 2001, 39(12): 45-48. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHEK200112019.htm
    [9]
    刘华, 翟文生. 翟文生教授治疗小儿难治性肾病经验介绍[J]. 新中医, 2010, 42(4): 97-98. https://www.cnki.com.cn/Article/CJFDTOTAL-REND201004055.htm

    LIU H, ZHAI WS. Professor Zhai Wensheng's experience in treating refractory nephropathy in children[J]. J N Chin Med, 2010, 42(4): 97-98. https://www.cnki.com.cn/Article/CJFDTOTAL-REND201004055.htm
    [10]
    马融. 中医儿科学[M]. 北京: 中国中医药出版社, 2018: 199-203.

    MA R. Pediatrics of Traditional Chinese Medicine[M]. Beijing: China traditional Chinese medicine press, 2018: 199-203.
    [11]
    李乐. 基于生存量表和中医证候的小儿难治性肾病临床疗效评价方法研究[D]. 郑州: 河南中医药大学, 2018.

    LI L. Research on the clinical efficacy evaluation method of pediatric refractory nephropathy based on survival scale and TCM syndrome[D]. Zhengzhou: Henan University of Traditional Chinese Medicine, 2018.
    [12]
    KIM JS, HAN SY, IREMONGER KJ. Stress experience and hormone feedback tune distinct components of hypothalamic CRH neuron activity[J]. Nat Commun, 2019, 10(1): 5696. doi: 10.1038/s41467-019-13639-8
    [13]
    MONTES-VILLARREAL J, PEREZ-ARREDONDO LA, RODRIGUEZ-GUTIERREZ R, et al. Serum morning cortisol as a screening test for adrenal insufficiency[J]. Endocr Pract, 2020, 26(1): 30-35. doi: 10.4158/EP-2019-0327
    [14]
    FOCKE CMB, IREMONGER KJ. Rhythmicity matters: Circadian and ultradian patterns of HPA axis activity[J]. Mol Cell Endocrinol, 2020, 501: 110652. doi: 10.1016/j.mce.2019.110652
    [15]
    SCHERHOLZ ML, SCHLESINGER N, ANDROULAKIS IP. Chronopharmacology of glucocorticoids[J]. Adv Drug Deliv Rev, 2019, 151/152: 245-261. doi: 10.1016/j.addr.2019.02.004
    [16]
    KAPUGI M, CUNNINGHAM K. Corticosteroids[J]. Orthop Nurs, 2019, 38(5): 336-339. doi: 10.1097/NOR.0000000000000595
    [17]
    夏正坤. 糖皮质激素临床应用再认识[J]. 医学研究生学报, 2018, 31(2): 113-117. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201802002.htm

    XIA ZK. The recognition of clinical application of glucocorticoids[J]. J Med Postgrad, 2018, 31(2): 113-117. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB201802002.htm
    [18]
    PARAGLIOLA RM, PAPI G, PONTECORVI A, et al. Treatment with synthetic glucocorticoids and the hypothalamus-pituitary-adrenal axis[J]. Int J Mol Sci, 2017, 18(10): 2201.
    [19]
    PARAGLIOLA RM, CORSELLO SM. Secondary adrenal insufficiency: From the physiopathology to the possible role of modified-release hydrocortisone treatment[J]. Minerva Endocrinol, 2018, 43(2): 183-197.
    [20]
    高洁, 蒋志滨, 李文, 等. 基于维生素D轴探讨黄芪多糖对脓毒症肾上腺皮质功能的保护机制[J]. 中华中医药学刊, 2019, 37(8): 1910-1912. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201908027.htm

    GAO J, JIANG ZB, LI W, et al. Protective mechanism of Astragalus polysaccharides on adrenal cortex function in sepsis based on VitaminD axis[J]. Chin Arch Tradit Chin Med, 2019, 37(8): 1910-1912. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201908027.htm
    [21]
    杨丽潇, 张碧丽, 王文红. 大剂量糖皮质激素应用过程中早期给予ACTH大鼠下丘脑-垂体-肾上腺轴的功能及病理变化[J]. 山东医药, 2016, 56(43): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201643007.htm

    YANG LX, ZHANG BL, WANG WH. Functional and pathological changes of HPA axis of rats in the early-stage application of ACTH during the process of using a large dose of glucocorticoid[J]. Shandong Med J, 2016, 56(43): 22-25. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201643007.htm
    [22]
    SPIGA F, WAITE EJ, LIU Y, et al. ACTH-dependent ultradian rhythm of corticosterone secretion[J]. Endocrinology, 2011, 152(4): 1448-1457.
    [23]
    CAPLAN A, FETT N, ROSENBACH M, et al. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Ocular, cardiovascular, muscular, and psychiatric side effects and issues unique to pediatric patients[J]. J Am Acad Dermatol, 2017, 76(2): 201-207.
    [24]
    HAHN D, SAMUEL SM, WILLIS NS, et al. Corticosteroid therapy for nephrotic syndrome in children[J]. Cochrane Database Syst Rev, 2020, 2020(8): CD001533.
    [25]
    SCHERHOLZ ML, SCHLESINGER N, ANDROULAKIS IP. Chronopharmacology of glucocorticoids[J]. Adv Drug Deliv Rev, 2019, 151/152: 245-261.
    [26]
    BROERSEN LH, PEREIRA AM, JØRGENSEN JO, et al. Adrenal insufficiency in corticosteroids use: Systematic review and meta-analysis[J]. J Clin Endocrinol Metab, 2015, 100(6): 2171-2180.
    [27]
    王春芳, 田文国, 陈金鹏, 等. 中药抗抑郁作用及其机制研究进展[J]. 中草药, 2022, 53(9): 2890-2901. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202209031.htm

    WANG CF, TIAN WG, CHEN JP, et al. Research progress on antidepressive effect and mechanism of traditional Chinese medicine[J]. Chin Tradit Herb Drugs, 2022, 53(9): 2890-2901. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202209031.htm
    [28]
    王雪峰, 张秀英, 王美娇. 基于"少火生气, 壮火食气"理论论治儿童难治性肾病综合征[J]. 中医杂志, 2019, 60(16): 1428-1430. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201916018.htm

    WANG XF, ZHANG XY, WANG MJ. Treating children refractory nephrotic syndrome based on the theory of "mild fire supplements Qi, strong fire reduces Qi"[J]. J Tradit Chin Med, 2019, 60(16): 1428-1430. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201916018.htm
    [29]
    刘晓丽, 何学红. 中药在激素治疗肾病综合征过程中的临床应用[J]. 辽宁中医药大学学报, 2008, 10(12): 52-52. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB200812026.htm

    LIU XL, HE XH. Clinical application of traditional Chinese medicine in the process of hormone treatment of nephrotic syndrome[J]. J Liaoning Univ Tradit Chin Med, 2008, 10(12): 52. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB200812026.htm
    [30]
    刘洋, 刘晓鹰, 张雪荣. 麻黄附子细辛汤治疗儿童难治性肾病激素拖尾期外感病的疗效分析[J]. 世界中西医结合杂志, 2021, 16(7): 1181-1183, 1195. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202107002.htm

    LIU Y, LIU XY, ZHANG XR. Efficacy analysis of Mahuang Fuzi Xixin Decoction in treating children's refractory nephropathy in hormone tailing stage exopathic disease[J]. World J Integr Tradit West Med, 2021, 16(7): 1181-1183, 1195. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZX202107002.htm
    [31]
    赵洁, 高洁, 张孟之, 等. 黄芪多糖对脓毒血症大鼠模型肾上腺皮质醇相关合成酶及维生素D轴的影响[J]. 中华中医药学刊, 2022, 40(3): 111-114, 269. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202203025.htm

    ZHAO J, GAO J, ZHANG MZ, et al. Effects of Astragalus polysaccharides on adrenal cortisol related synthases and vitamin D axis in septic rats[J]. Chin Arch Tradit Chin Med, 2022, 40(3): 111-114, 269. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202203025.htm
    [32]
    钟淑娟, 郑思超, 丘秀玉, 等. 丹参素钠对慢性不可预知温和应激模型小鼠的抗抑郁作用[J]. 中国新药杂志, 2018, 27(23): 2819-2824. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYZ201823017.htm

    ZHONG SJ, ZHENG SC, QIU XY, et al. Anti-depressant effects of Tanshinol Sodium in chronic unpredicted mild stress mice[J]. Chin J N Drugs, 2018, 27(23): 2819-2824. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYZ201823017.htm
    [33]
    LEE B, SUR B, PARK J, et al. Chronic administration of baicalein decreases depression-like behavior induced by repeated restraint stress in rats[J]. Korean J Physiol Pharmacol, 2013, 17(5): 393-403.
    [34]
    王越, 廖生俊, 鲁敏翔, 等. 黄芩苷对慢性应激抑郁模型大鼠海马内神经营养因子及下丘脑-腺垂体-肾上腺轴的影响[J]. 中南药学, 2016, 14(3): 274-277. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX201603015.htm

    WANG Y, LIAO SJ, LU MX, et al. Effect of baicalin on expression of neurotrophic factors and HPA axis in depression rat model induced by stress[J]. Cent South Pharm, 2016, 14(3): 274-277. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX201603015.htm
    [35]
    李海燕, 潘彦舒, 程晓娜, 等. 黄芩苷对缺血性脑损伤雄性大鼠脑保护作用的机制研究[J]. 中国中医药信息杂志, 2017, 24(6): 35-38. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY201706009.htm

    LI HY, PAN YS, CHENG XN, et al. Study on mechanism of protective effects of baicalin on male rats with ischemic brain injury[J]. Chin J Inf Tradit Chin Med, 2017, 24(6): 35-38. https://www.cnki.com.cn/Article/CJFDTOTAL-XXYY201706009.htm
    [36]
    苗雨露, 张雯霞, 王玉娥, 等. 清热解毒类中药抗炎机制研究进展[J]. 中国实验方剂学杂志, 2018, 24(9): 228-234. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201809036.htm

    MIAO YL, ZHANG WX, WANG Y, et al. Anti-inflammatory mechanism of antipyretic and detoxifying traditional Chinese medicine[J]. Chin J Exp Tradit Med Formulae, 2018, 24(9): 228-234. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201809036.htm
    [37]
    倪锦玉, 翟文生, 李乐, 等. 益气化瘀清热方序贯辨证治疗儿童难治性肾病综合征临床疗效观察[J]. 中国实验方剂学杂志, 2022, 28(4): 116-123. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202204015.htm

    NI JY, ZHAI WS, LI L, et al. Sequential treatment with syndrome differentiation on children's refractory nephrotic syndrome with Yiqi Huayu Qingre prescription[J]. Chin J Exp Tradit Med Formulae, 2022, 28(4): 116-123. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX202204015.htm
    [38]
    翟文生, 杨濛, 张建, 等. 益气化瘀清热方及其拆方对嘌呤霉素氨基核苷损伤小鼠足细胞表达TRPC6的影响[J]. 中华中医药学刊, 2018, 36(1): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202005006.htm

    ZHAI WS, YANG M, ZHANG J, et al. Effect of Yiqi Huayu Qingre prescription and its separations on expression of podocyte TRPC6 of mice injuried by puromycin aminonucleoside[J]. Chin Arch Tradit Chin Med, 2018, 36(1): 14-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202005006.htm
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(9)

    Article Metrics

    Article views (114) PDF downloads(8) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return