本文選題：兒童/小兒過敏性紫癜　切入點(diǎn)：祛風(fēng)滋陰法　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究旨在通過觀察西醫(yī)基礎(chǔ)治療上加用以祛風(fēng)滋陰為大法的中成藥制劑(槐杞黃顆粒)治療小兒過敏性紫癜(henoch-schonlein/allergic purpura,HSP或AP)與單純西醫(yī)基礎(chǔ)治療的療效比較,以探討祛風(fēng)滋陰法對HSP的治療作用及其可能的作用機(jī)制,并尋求一種安全有效的治療HSP的中成藥制劑,以提供一種優(yōu)化治療方案。方法符合納入標(biāo)準(zhǔn)的HSP患兒200例均來自于大連市兒童醫(yī)院中醫(yī)科、皮膚科門診、腎內(nèi)科住院。隨機(jī)分為2組,即觀察組和對照組各占100例。西醫(yī)基礎(chǔ)治療:維生素C、蘆丁片、氯雷他定片常規(guī)口服;若有明顯感染,給予敏感抗生素;酌情應(yīng)用糖皮質(zhì)激素。(腎上腺糖皮質(zhì)激素規(guī)范:有中重度消化道出血或血管神經(jīng)水腫者,應(yīng)用地塞米松0.25-0.75mg/kg靜點(diǎn)或口服強(qiáng)的松1-1.5mg/kg。)觀察組:西藥基礎(chǔ)治療同上。加服槐杞黃顆粒,每次1袋,Bid。對照組:予西醫(yī)基礎(chǔ)治療。療程:4周為1療程,連續(xù)用藥3個(gè)療程,并隨訪1年。將兩組臨床療效及主要癥狀消失時(shí)間、復(fù)發(fā)率、治療結(jié)束時(shí)兩組紫癜性腎炎發(fā)生情況進(jìn)行比較對照。觀察兩組患兒治療前后細(xì)胞免疫、血清及尿肝細(xì)胞生長因子(hepatocyte growth factor,HGF)水平變化。結(jié)果1.從臨床療效來看,觀察組與對照組的總有效率分別為94.0%和73.0%,兩組總有效率有顯著統(tǒng)計(jì)學(xué)差異,P0.001,提示觀察組的臨療療效明顯比對照組好。2.從兩組主要癥狀消失時(shí)間上看,經(jīng)檢驗(yàn),兩組在紫癜消失時(shí)間與腹痛消失時(shí)間上比較,P均0.05,有顯著性差別,結(jié)果提示觀察組在紫癜消失時(shí)間與腹痛消失時(shí)間上較對照組好;關(guān)節(jié)疼痛消失時(shí)間比較,P0.05,兩組不存在顯著差別。3.從治療結(jié)束時(shí)兩組紫癜性腎炎發(fā)生情況看,觀察組發(fā)生腎損害者的程度較對照組輕,紫癜性腎炎的發(fā)生例數(shù)較對照組少。4.兩組治療前后血清和尿HGF水平變化比較,2組治療前基線水平對比差異無統(tǒng)計(jì)學(xué)意義。與本組治療前比較,兩組治療后血清及尿HGF水平均較治療前降低(P0.05),但觀察組治療前后血清及尿肝細(xì)胞生長因子水平的減少量顯著高于對照組。5.治療結(jié)束時(shí)兩組患兒治療前后外周血CD4+與CD8+水平變化比較,與本組治療前比較,2組均有顯著統(tǒng)計(jì)學(xué)差異(P0.05),但觀察組CD4+,CD8+與CD4+/CD8+水平變量均顯著高于對照組(P均0.01),提示觀察組較對照組對細(xì)胞免疫的調(diào)整更為明顯,P0.05。6.兩組患兒復(fù)發(fā)率比較顯示:觀察組復(fù)發(fā)率4%,對照組復(fù)發(fā)率24%,P0.001,差異有統(tǒng)計(jì)學(xué)意義,說明觀察組的復(fù)發(fā)率顯著低于對照組。結(jié)論1.祛風(fēng)滋陰法治療兒童HSP臨床綜合療效顯著,可以顯著縮短患兒紫癜與腹痛癥狀的消失時(shí)間,縮短病程。2.祛風(fēng)滋陰法治療兒童HSP,通過調(diào)整患兒的細(xì)胞免疫功能,提升了患兒抵抗和預(yù)防疾病的能力,明顯降低了復(fù)發(fā)率,有效預(yù)防了HSPN的發(fā)生。3.治療HSP過程中動態(tài)監(jiān)測血清及尿HGF可能對判斷病情起到重要作用,初步推測以祛風(fēng)滋陰為大法的槐杞黃治療HSP的可能機(jī)制是通過影響血清及尿HGF水平來發(fā)揮抗炎及修復(fù)損傷內(nèi)皮細(xì)胞作用的。4.以祛風(fēng)滋陰法為治療原則,應(yīng)用中成藥制劑“槐杞黃顆粒”治療兒童HSP安全且副作用甚微,攜帶保存方便,口感佳,患兒樂于接受,家長依從性高,可廣泛推廣于HSP的臨床治療中。
[Abstract]:The purpose of this study is to observe the basic treatment of Western medicine combined with traditional Chinese medicine for nourishing yin and Dafa wind (Huai Qi Huang Keli) in the treatment of Henoch Schonlein purpura (henoch-schonlein/allergic purpura, HSP or AP) compared with the efficacy of simple treatment, to explore the method of Nourishing Yin Qufeng therapy for HSP effect and possible mechanism of traditional Chinese medicine preparation and to seek a safe and effective treatment of HSP, in order to provide an optimal treatment. Methods met the inclusion criteria of 200 HSP patients were from the Department of traditional Chinese medicine, Dalian children's Hospital Outpatient Department of Dermatology, Department of Nephrology hospital were randomly divided into 2 groups: observation group and control group 100 cases. The basis of Western medicine treatment: vitamin C, Rutinum Tablets, Loratadine Tablets, conventional oral; if there was infection, giving antibiotics; appropriate glucocorticoids. (glucocorticoid specification: in weight The degree of gastrointestinal bleeding or vascular nerve edema, dexamethasone 0.25-0.75mg/kg intravenous or oral prednisone 1-1.5mg/kg.) observation group: Western medicine therapy ibid. With Huaiqihuang granules, 1 per bag, Bid. control group treated with western medicine treatment: 4 weeks of continuous medication for 1 courses, 3 courses, and follow up 1 years. The main symptoms and clinical efficacy of the two groups disappeared time, recurrence rate, end of treatment group two purpura nephritis incidence were compared. Two groups were observed before and after treatment of cellular immunity, serum and urine of hepatocyte growth factor (hepatocyte growth, factor, HGF) level. The results from 1. clinical. The observation group and the control group in the total efficiency were 94% and 73%, the total efficiency of two groups had significant difference, P0.001, prompt treatment on the curative effect of observation group was better than the control group.2. from the two main groups of symptoms disappeared time Look, after inspection, the two groups were compared with purpura disappearance time of abdominal pain disappeared time, P was 0.05, there was significant difference between the results in the observation group, purpura disappeared time and abdominal pain disappeared time than the control group; joint pain disappeared time, P0.05, the two groups are not significant difference between the two groups from.3. at the end of treatment of purpura nephritis occurrence situation, the observation group occurred in renal damage degree were lighter than the control group, the number of cases of purpura nephritis compared with control serum and urine levels of HGF group before and after.4. treatment in the two groups, the 2 groups before treatment on baseline than no significant differences compared with the group. Before treatment, the two groups after treatment of serum and urine HGF levels were lower than those before treatment (P0.05), but the observation group before and after treatment with growth factor levels in serum and urine of liver cells was significantly higher than the control group to reduce the amount of the end of the.5. treatment in two groups before and after treatment of peripheral blood Comparison of CD4+ and CD8+ level, compared with the group before treatment, the 2 groups were statistically significant differences (P0.05), but the observation group CD4+, CD8+ and CD4+/CD8+ level variables were significantly higher than control group (P < 0.01), suggesting that the observation group than in the control group on the cell immune adjustment is more obvious, P0.05.6. of two groups the recurrence rate comparison showed that the recurrence rate of the observation group was 4%, the recurrence rate of the control group 24%, P0.001, the difference was statistically significant, indicating the recurrence rate of the observation group was significantly lower than the control group. Conclusion the 1. wind nourishing Yin in treating children with HSP clinical comprehensive curative effect, can significantly shorten the disappearance time of children with purpura and abdominal pain symptoms, shorten the course of.2. Qufeng nourishing yin method in treating children with HSP, the cellular immune function to adjust the children, enhance the ability of children to resist and prevent disease, significantly reduces the recurrence rate, effectively prevent the occurrence of dynamic monitoring of blood.3. in treatment of HSP in the process of HSPN Clear and urinary HGF may play an important role in diagnosis, speculated that the wind Yin for Dafa Huaiqihuang treatment of HSP may play an anti-inflammatory mechanism is to repair the damage of endothelial cells and the effect of serum and urine levels of HGF.4. in Qufeng nourishing yin for the treatment of the principle, should use the traditional Chinese Medicine preparation "Huaiqihuang Granule" in the treatment of children HSP safe and side effect, convenient carrying and preservation, good taste, children are willing to accept high compliance of parents, can be widely used in the clinical treatment of HSP.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R272

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