本文選題：兒童原發(fā)性腎病綜合征 + 人中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白　； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察益腎活血法干預(yù)小兒原發(fā)性腎病綜合征(Primary Nephritic Syndrome,PNS)對(duì)人中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白(Neutrophil Ge 1 atinase Associated Lipocalin,NGAL)及人肝型脂肪酸結(jié)合蛋白(Liver-type Fatty Acid Binding Protein,L-FABP)的影響,進(jìn)一步完善小兒PNS的發(fā)病機(jī)制及益腎活血中藥腎康靈治療的作用機(jī)理,達(dá)到提高臨床療效,減少藥物不良反應(yīng)的目的。方法:選取門診和病房PNS(單純型,頻復(fù)發(fā))患兒40例,采用隨機(jī)數(shù)字表法將病例分為中西醫(yī)結(jié)合治療組(A組)20例和西藥對(duì)照組(B組)20例,另外選取健康兒童20例作為健康對(duì)照組(C組)。B組采取單純西藥治療,A組在B組治療的基礎(chǔ)上加用益腎活血中藥腎康靈煎劑(組成:黃芪、生地黃、山茱萸、山藥、茯苓、牡丹皮、三七、赤芍等)。運(yùn)用酶聯(lián)免疫吸附法(ELISA)檢測(cè)各組治療前和治療后1、3個(gè)月的尿NGAL、尿L-FABP水平變化,應(yīng)用SPSS20.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.治療前比較,A、B兩組尿NGAL、尿L-FABP水平較C組明顯升高(P均0.01),而A、B兩組比較無顯著差異(P均0.05);A、B兩組血清胱抑素、血肌酐、尿α1微球蛋白、尿蛋白、血清白蛋白、膽固醇、甘油三酯水平比較無顯著差異(P均0.05)。2.治療1個(gè)月后,A、B兩組尿NGAL、尿L-FABP、尿α1微球蛋白、尿蛋白水平均較治療前明顯降低(P均0.01),A組尿L-FABP、尿蛋白水平低于B組(P尿L-FABP0.05,P尿蛋白0.01),A組尿NGAL水平明顯高于B組(P0.01),A、B兩組尿α1微球蛋白水平無顯著差異(P0.05);A組膽固醇、甘油三酯水平較治療前降低(P膽固醇0.01,P甘油三酯0.05),B組膽固醇、甘油三酯水平較治療前無顯著差異(P均0.05),A組低于B組(P均0.05);A、B兩組血清胱抑素、血肌酐水平較治療前無顯著差異(P均0.05),A、B兩組比較無顯著差異(P均0.05);A、B兩組血清白蛋白較前明顯升高(P 均0,01),A 組高于 B 組(P0.05)。3.治療3個(gè)月后,與治療前比較A、B兩組尿NGAL、尿L-FABP、尿α1微球蛋白、尿蛋白、膽固醇、甘油三酯水平均明顯降低(PB-甘油三酯0.05,余P0.01),A、B兩組血清白蛋白水平明顯升高(P均0.01),A、B兩組血清胱抑素、血肌酐無顯著差異(P均0.05);與治療1個(gè)月后比較,A組尿NGAL水平明顯降低(P0.01)、B組無顯著差異(P0.05),A組尿L-FABP水平無顯著差異(P0.05)、B組明顯降低(P0.01),A、B兩組血清胱抑素、血肌酐無顯著差異(P均0.05),A、B兩組尿α1微球蛋白、尿蛋白、膽固醇、甘油三酯水平均明顯降低(PA-尿蛋白0.05,PB-膽固醇0.05,PB-甘油三酯0.05,余P0.01),A、B兩組血清白蛋白明顯升高(P均0.01);A組與B組比較尿NGAL、尿L-FABP、尿α1微球蛋白、血清胱抑素、血肌酐水平均無顯著差異(P均0.05),A組尿蛋白、膽固醇、甘油三酯水平低于B組(P尿蛋白0.05,P膽固醇0.05,P甘油三酯0.01),A組血清白蛋白水平高于B組(P0.05)。結(jié)論:1.PNS患兒的尿NGAL、尿L-FABP水平明顯升高,提示NGAL、L-FABP可能參與兒童PNS的發(fā)病機(jī)制。2.應(yīng)用中藥腎康靈治療后尿L-FABP下降明顯,治療1個(gè)月后治療組指標(biāo)水平低于對(duì)照組,中藥腎康靈可能對(duì)降低患兒尿NGAL水平有一定作用,中藥結(jié)合西藥治療,可能有助于減輕腎小管-間質(zhì)損傷的程度。3.中西醫(yī)結(jié)合治療在降低異常升高的尿蛋白、血脂,升高血白蛋白等方面療效優(yōu)于單純西藥組,提示益腎活血法能改善患兒脂質(zhì)代謝紊亂和高凝狀態(tài),從而緩解患兒病情,提高臨床療效。4.NGAL、L-FABP較血清胱抑素、血肌酐優(yōu)先反映腎小管的損傷,可作為早期腎小管-間質(zhì)損傷的生物學(xué)標(biāo)志,為PNS的臨床治療和預(yù)后判斷提供客觀指標(biāo)。
[Abstract]:Objective: To observe the effect of Primary Nephritic Syndrome (PNS) on human neutrophil gelatinase related lipid carrier protein (Neutrophil Ge 1 atinase Associated Lipocalin, NGAL) and human hepatoid fatty acid combined egg white (Liver-type Fatty) by observing the kidney and activating blood and blood activating method. To further improve the pathogenesis of children's PNS and the mechanism of Yishen activating and blood activating medicine Shen Kang Ling treatment mechanism, to improve the clinical effect and reduce the adverse drug reaction. Methods: 40 cases of PNS (simple type, frequency recurrence) in the outpatient and ward were selected, and the cases were divided into 20 cases and Western medicine group (group A) with the combination of traditional Chinese and Western Medicine (Group) and Western medicine. In the control group (group B), 20 healthy children were selected as the healthy control group (group C) and group.B was treated with pure western medicine. Group A was treated with Yishen Huoxue Chinese medicine Shen Kang Ling Decoction (composed of Astragalus, rehmannia, cornel, yam, tuckahoe, peony, peony, 37, red peony) on the basis of B group treatment. The enzyme linked immunosorbent assay (ELISA) was used to detect each group. The changes of urine NGAL and urine L-FABP level before and after 1,3 months after treatment were statistically analyzed with SPSS20.0 software. Results: 1. before treatment, A, B two groups were urine NGAL, the level of urine L-FABP was significantly higher than that in the C group (P 0.01), while A, B two had no significant difference (all 0.05). There was no significant difference in protein, urine protein, serum albumin, cholesterol and triglyceride (P 0.05).2. treatment for 1 months, A, B two groups of urine NGAL, urine L-FABP, urinary alpha 1 microglobulin, urinary protein levels were significantly lower than before treatment (P 0.01), A group urine L-FABP, urine protein level was lower than the B group (P Uria L-FABP0.05, proteinuria 0.01) There was no significant difference in the level of urinary alpha 1 microglobulin in A and B two groups (P0.05). The level of cholesterol and triglyceride in group A was lower than before treatment (P cholesterol 0.01, P triglyceride 0.05), B group cholesterol and triglyceride level was no significant difference compared with before treatment (P 0.05), A group was lower than that of B group (0.05); two groups of serum cystatin and serum creatinine water There was no significant difference before treatment (P 0.05), A and B two groups (P 0.05), A, B two increased significantly (P 0,01), A group was higher than B group (P0.05).3. treatment 3 months later, compared with before treatment, two groups of urine, urinary alpha 1 microglobulin, urinary protein, cholesterol, triglyceride levels were significantly reduced. B- triglyceride 0.05, residual P0.01), A, B two serum albumin level increased significantly (P 0.01), A, B two serum cystatin, serum creatinine no significant difference (P 0.05). Compared with the 1 months after treatment, the A group urine NGAL level decreased significantly (P0.01), B group, there was no significant difference There was no significant difference in serum cystatin and serum creatinine in B two groups (P 0.05), A and B two groups of urinary alpha 1 microglobulin, urinary protein, cholesterol, triglyceride level decreased significantly (PA- urine protein 0.05, PB- cholesterol 0.05, PB- triglyceride 0.05, residual P0.01), A, B two (P all 0.01); A group compared urine, urine, and urinary alpha 1 microspheres The levels of protein, serum cystatin and serum creatinine were not significantly different (P 0.05). The level of urine protein, cholesterol and triglyceride in group A was lower than that in group B (P urine protein 0.05, P cholesterol 0.05, P triglyceride 0.01). The serum albumin level in A group was higher than that of group B (P0.05). Conclusion: the urine NGAL, urinary L-FABP level of 1.PNS children was significantly higher. The pathogenesis of PNS in children was significantly lower than that of the control group after treatment with Chinese medicine Shen Kang Ling. After 1 months of treatment, the index level of the treatment group was lower than that of the control group. The Chinese medicine Shen Kang Ling may have a certain effect on reducing the NGAL level in the urine of the children. The combination of traditional Chinese medicine and Western medicine may help to reduce the degree of renal tubulointerstitial injury by the combination of Chinese and Western medicine. It is better to reduce the abnormal increase of urine protein, blood lipid, increase blood albumin and other aspects than the simple western medicine group, suggesting that Yishen activating blood method can improve the disorder of lipid metabolism and hypercoagulability in children, thus relieving the disease of the children and improving the clinical efficacy of.4.NGAL, L-FABP is compared with serum cystatin, and the blood creatinine is a priority to reflect the injury of renal tubules, which can be used as an early stage. Biomarkers of tubulointerstitial injury provide objective indicators for the clinical treatment and prognosis of PNS.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R272

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