本文選題：過敏性紫癜性腎炎 + 兒童�。� 參考：《遼寧中醫(yī)藥大學(xué)》2013年博士論文

【摘要】：目的：通過對復(fù)腎湯治療濕熱瘀阻型小兒過敏性紫癜性腎炎的臨床研究，觀察其臨床療效及用藥安全性，從而為臨床治療小兒過敏性紫癜性腎炎提供更有效的治療藥物。 方法：本次臨床觀察所選病例均為確診為小兒過敏性紫癜性腎炎（血尿和/或蛋白尿型）的患兒，采用隨機(jī)對照的原則將60例入選病例隨機(jī)分為中醫(yī)治療組（以下簡稱治療組）及雷公藤對照組（以下簡稱對照組）兩組，每組各30例。兩組都接受相同的基礎(chǔ)治療，包括注意脫敏飲食、避免劇烈運動、注意預(yù)防感冒，另外均口服VC、VE、蘆丁、潘生丁等基礎(chǔ)藥物，對照組在基礎(chǔ)治療之上口服雷公藤多苷片，1mg/kg·d，分3次飯后口服；治療組在基礎(chǔ)治療的同時，采用導(dǎo)師經(jīng)驗中藥方復(fù)腎湯口服。兩組均以1個月為1個療程，觀察3個療程。治療結(jié)束后，觀察臨床療效，并對所有未脫落的病例進(jìn)行為期3個月的隨訪觀察，總結(jié)臨床結(jié)果。 結(jié)果： 1.兩組治療前的一般資料、臨床癥狀、體征、中醫(yī)證候積分、尿紅細(xì)胞計數(shù)、24小時蛋白量及其它所選觀察的理化檢驗指標(biāo)均無顯著性差異，經(jīng)統(tǒng)計學(xué)分析（P＞0.05），具有可比性。 2.兩組治療前后疾病療效愈顯率及臨床總有效率的比較中，結(jié)果顯示：治療組愈顯率為64.3%，臨床總有效率為92.9%，對照組愈顯率為33.3%，臨床總有效率為70.4%，兩組相比，無論是在愈顯率方面還是在臨床總有效率方面，均具有顯著性差異（P＜0.05）。統(tǒng)計結(jié)果分析可知，治療組療效優(yōu)于對照組。 3.兩組治療前后中醫(yī)證候總積分的比較中，結(jié)果顯示：治療組的治療前積分為11.63±2.42，治療后積分為2.58±1.62，對照組的治療前積分為11.37±2.61，治療后積分為6.62±2.41，兩組在治療后與治療前相比，存在顯著性差異（P＜0.05），說明治療組與對照組的中醫(yī)證候積分均明顯降低，治療后優(yōu)于治療前。治療后治療組的中醫(yī)證候總積分與對照組治療后中醫(yī)證候總積分相比，有顯著性差異（P＜0.05），說明治療組在改善中醫(yī)證候方面優(yōu)于對照組。 兩組治療前后中醫(yī)證候療效愈顯率及臨床總有效率的比較中，結(jié)果顯示：治療組愈顯率為85.7%，臨床總有效率為100.0%，對照組愈顯率為51.9%，臨床總有效率為81.5%，兩組相比，無論是在愈顯率方面還是在臨床總有效率方面，經(jīng)統(tǒng)計學(xué)對比，，均具有顯著性差異（P＜0.05）。統(tǒng)計結(jié)果分析可知，治療組療效優(yōu)于對照組。 4.兩組治療前后尿紅細(xì)胞計數(shù)的比較中，結(jié)果顯示：兩組在治療后與治療前相比，存在顯著性差異（P＜0.05），說明治療組與對照組的尿紅細(xì)胞計數(shù)均明顯降低，治療后優(yōu)于治療前。治療后治療組的尿紅細(xì)胞計數(shù)與對照組治療后尿紅細(xì)胞計數(shù)相比有顯著性差異（P＜0.05），說明治療組在減少紫癜性腎炎尿紅細(xì)胞計數(shù)方面優(yōu)于對照組。 兩組治療前后24小時尿蛋白定量的比較中，結(jié)果顯示：兩組在治療后與治療前相比，存在顯著性差異（P＜0.05），說明治療組與對照組的24小時尿蛋白定量均明顯降低，治療后優(yōu)于治療前。但治療后治療組的24小時尿蛋白定量與對照組治療后24小時尿蛋白定量相比無顯著性差異（P＞0.05），說明治療組在減少紫癜性腎炎24小時尿蛋白定量方面沒有明顯優(yōu)勢。 在本次臨床觀察中，治療組在對降低尿β2-微球蛋白、尿微量白蛋白，調(diào)節(jié)免疫球蛋白IgA、IgG以及降低血小板計數(shù)、改善血液凝血功能等方面均明顯優(yōu)于對照組，經(jīng)統(tǒng)計學(xué)分析，存在顯著性差異（P＜0.05）。 5.觀察兩組治療后的復(fù)發(fā)率方面比較，結(jié)果顯示：治療組的隨訪復(fù)發(fā)率為5.6%，對照組的隨訪復(fù)發(fā)率為33.3%，存在統(tǒng)計學(xué)差異（P＜0.05）；在兩組治療期間，治療組不良反應(yīng)發(fā)生例數(shù)明顯低于對照組，兩組相比，存在統(tǒng)計學(xué)差異（P＜0.05）。 結(jié)論： 1.臨床表現(xiàn)血尿和/或蛋白尿為主的小兒過敏性紫癜性腎炎通過臨床中醫(yī)辨證屬濕熱瘀阻型者采用中藥復(fù)腎湯治療，具有較好地減少尿紅細(xì)胞及尿蛋白的作用。 2.復(fù)腎湯能明顯改善濕熱瘀阻型過敏性紫癜性腎炎的中醫(yī)臨床證候，且無明顯副作用。但復(fù)腎湯對減少尿蛋白的作用與雷公藤多苷片相比沒有明顯優(yōu)勢，雷公藤多苷片雖然有較好的減少尿蛋白的作用，但在減少紫癜腎血尿癥狀及中醫(yī)臨床證候方面不如中藥復(fù)腎湯，且有一定的副作用。 3.通過觀察復(fù)腎湯對過敏性紫癜性腎炎治療前后免疫球蛋白IgA、IgG、IgM以及血小板及凝血功能的影響，表明本病的作用機(jī)制可能與炎癥反應(yīng)、免疫功能、血液高凝狀態(tài)等因素有關(guān)，但具體機(jī)制如何以及是否存在其它作用機(jī)制有待于今后進(jìn)一步深入研究。
[Abstract]:Objective : To observe the clinical efficacy and safety of Fu Shen Tang in the treatment of allergic purpura nephritis in children with damp heat and blood stasis , thus providing more effective therapeutic drugs for the clinical treatment of children allergic purpura nephritis .

Methods : All selected cases of this clinical observation were diagnosed as children with Henoch - Schonlein purpura nephritis ( hematuria and / or proteinuria ) . Sixty patients were randomly divided into two groups : traditional Chinese medicine treatment group ( hereinafter referred to as the treatment group ) and the control group ( hereinafter referred to as control group ) .
At the same time , the treatment group was taken orally with a tutor ' s experience in the treatment of basic therapy . The two groups were treated with one month as one treatment course and three treatment courses were observed . After the treatment was completed , the clinical curative effect was observed , and all the cases which were not shed were followed up for 3 months , and the clinical results were summarized .

Results :

1 . There was no significant difference in general data , clinical symptoms , signs , traditional Chinese medicine syndrome score , urine red blood cell count , 24 hour protein amount and other physical and chemical examination indexes before treatment in both groups , and the statistical analysis ( P > 0.05 ) showed comparability .

2 . Compared with the control group , the clinical total effective rate was 64.3 % , the total effective rate was 92.9 % , the rate of clinical total effective rate was 33.3 % , the clinical total effective rate was 70.4 % .

3 . Compared with the control group , there was significant difference between treatment group and control group ( P & lt ; 0.05 ) , and the score of TCM syndrome differentiation was significantly lower than that in control group ( P & lt ; 0.05 ) .

Compared with the control group , the clinical total effective rate was 85.7 % , the clinical total effective rate was 100.0 % , the rate of clinical total effective rate was 51.9 % , the clinical total effective rate was 81.5 % .

4 . Compared with the control group , there was a significant difference between treatment group and control group before and after treatment ( P < 0 . 05 ) . Compared with the control group , there was a significant difference between treatment group and control group ( P < 0.05 ) .

Compared with the control group , the 24 - hour urinary protein in the treatment group was significantly lower than that in the control group ( P > 0.05 ) , but there was no significant difference in 24 - hour urinary protein ration between the treatment group and the control group ( P > 0.05 ) .

In this clinical observation , the treatment group was obviously superior to the control group in the aspects of decreasing urinary 尾 2 - microglobin , urinary microalbumin , regulating immunoglobulin IgA , IgG and lowering platelet count , improving blood coagulation function , etc . , and statistical analysis showed significant difference ( P < 0.05 ) .

5 . The results showed that the follow - up recurrence rate was 5.6 % in the treatment group and 33.3 % in the control group ( P < 0.05 ) .
The number of adverse reactions in the treatment group was significantly lower than that of the control group during the two groups of treatment ( P < 0.05 ) .

Conclusion :

1 . The clinical manifestation hematuria and / or proteinuria - based infantile allergic purpura nephritis is treated with traditional Chinese medicine complex kidney soup by the Chinese traditional Chinese medicine syndrome differentiation , and has the function of better reducing the urine red blood cell and the urinary protein .

2 . Fu Shen Tang can obviously improve the TCM clinical symptoms of damp - heat - stasis - type allergic purpura nephritis , and has no obvious side effect , but the effect of complex kidney decoction on reducing urinary protein is not obvious than that of tripterygium glycosides tablet .

3 . By observing the effects of complex kidney decoction on IgA , IgG , IgM and platelet and blood coagulation function before and after treatment of Henoch - Schonlein purpura nephritis , the mechanism of action of this disease may be related to the factors such as inflammation , immune function , blood hypercoagulability , etc . , but the specific mechanism and the existence of other mechanism of action are to be further studied in the future .

【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R272

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