中药联合激素非拖尾疗法治疗儿童难治性肾病综合征的临床研究

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

    摘要
  • 摘要:
      目的  观察中药联合激素非拖尾疗法治疗儿童难治性肾病综合征(RNS)的临床疗效。
      方法  将2019年6月至2022年6月在河南中医药大学第一附属医院门诊就诊的122例RNS患儿按照随机数字表法分为观察组(n=60)和对照组(n=62)。对照组给予泼尼松片联合他克莫司治疗, 其中泼尼松片治疗采用拖尾疗法, 观察组在对照组基础上加用中药治疗(益气化瘀清热方序贯辨治), 其中泼尼松片治疗采用非拖尾疗法。比较2组治疗前和治疗4周、12周、24周后24 h尿蛋白定量(24 h UTP)、血浆白蛋白(ALB)、血脂总胆固醇(TC)、甘油三酯(TG)的变化; 比较治疗前和治疗24周后肝肾功能丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血尿素氮(BUN)、血肌酐(SCr)、中医证候积分和儿童RNS中医生存质量量表的变化; 比较治疗52周后2组患儿激素总累积量、激素副作用、总有效率和复发率。
      结果  2组患儿治疗4周、12周、24周后24 h UTP、ALB、TC、TG均较治疗前有改善, 且观察组改善更明显(P < 0.05, P < 0.01);治疗24周后, 2组患儿ALT、AST、BUN、SCr无明显变化(P>0.05), 但中医证候积分均显著降低(P < 0.05, P < 0.01)、中医生存质量量表总积分显著增加(P < 0.01), 且观察组优于对照组(P < 0.05, P < 0.01);治疗52周后, 观察组激素总累积量低于对照组(P < 0.01)、激素副作用少于对照组(P < 0.01)、总有效率高于对照组(P < 0.05)、复发率低于对照组(P < 0.05)。
      结论  中药联合激素非拖尾疗法治疗儿童RNS能降低尿蛋白, 升高血浆白蛋白, 降低血脂, 改善中医证候, 提高生存质量, 提高临床疗效。

     

    Abstract:
      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 lipidstotal 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.

     

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