摘要
目的观察中药肾康灵煎剂治疗原发性肾病综合征(primary nephrotic syndrome,PNS)肾虚血瘀证患儿肾损伤的干预作用并探讨其机制。方法将65例PNS患儿按随机数字表法分为肾康灵煎剂加西药组(联合组,33例)和西药对照组(西药组,32例),同时在体检中心抽取健康体检儿童为健康对照组(对照组,30名)。西药组采用泼尼松治疗,用至尿蛋白转阴后2周改为隔日顿服疗法,疗程达1年以上,泼尼松无效应或部分效应者,加用环磷酰胺静脉冲击疗法,每2周连用2天,共6次,或用口服环孢素A;联合组在泼尼松治疗开始即加用肾康灵煎剂,水煎服,每天1剂,分2次口服,用至泼尼松停药后2个月为止。采用ELISA法检测各组治疗前后血清CXCL16、解聚素金属蛋白酶10(disintegrin metalloproteinase 10,ADAM10)、ADAM17、ALB、TC及24h尿蛋白定量,评价两组疗效。结果与本组治疗前比较,两个用药组治疗后CXCL16、ADAM10、ADAM17、TC水平及尿蛋白定量均降低,ALB升高(P<0.01)。与对照组同期比较,两个用药组治疗前后CXCL16、ADAM10、ADAM17、CH水平及尿蛋白定量均升高,ALB降低(P<0.01)。与西药组同期比较,联合组治疗后CXCL16、ADAM10、ADAM17、TC水平及尿蛋白定量均降低,联合组0.5、1年复发率及复发次数降低(P<0.01),联合组的完全缓解率升高(P<0.01)。结论肾康灵煎剂可通过降低CXCL16、ADAM10、ADAM17,降低PNS患儿尿蛋白、TC水平,升高血ALB,有效地改善PNS患儿预后。
Objective To observe the intervention of Shenkangling Decoction （SD） on the renal injury of primary nephrotic syndrome （PNS） children patients of Shen deficiency blood stasis syndrome （SDBSS） and to explore its mechanism. Methods Totally 65 PNS children patients were randomly assigned to the combined group （33 cases, treated by SD ＋Western medicine） and the Western medicine group （32 cases, treated by Western medicine）. Meanwhile, 30 healthy children were recruited as the healthy control group from the medical examination center. Those in the Western medicine group were treated with prednisone （5 mg per tablet） at the daily dose of 1.5 -2.0 mg/kg till two weeks after their urine protein turned to negative. Then the dosage was reduced once daily per every other day. The therapeutic course lasted for more than 1 year. For those with no effect of prednisone or partial effect, cyclophosphamide intravenous pulse therapy was additionally applied for 2 successive days per week, a total of 6 times, or they took cyclosporine A. Patients in the combined group additionally took SD while starting treatment of prednisone. SD was decocted in water for oral dose, once daily, taken in two portions until 2 months after prednisone was discontinued. Efficacy was evaluated based on serum levels of chemotactic factor CXCL16, disintegrin metalloproteinase 10 （ ADAM10 ）, disintegrin metalloproteinase 17 （ADAM17）, albumin （ALB）, total cholesterol （TC）, and 24-h urine protein excretion （UPE） detected by ELISA before and after treatment. Results Compared with before treatment in the same group, levels of CXCL16, ADAM10, ADAM17, TC, and 24-h UPE were significantly lower in the two treatment groups （P 〈0.01 ）. Compared with the control group, levels of CXCL16, ADAM10, ADAM17, TC, and 24-h UPE significantly increased, and the serum ALB level decreased in the two treatment groups （P 〈0.01 ）. Compared with the Western medicine group at the same time point, levels of CXCL16, ADAM10, ADAM17, TC, and 24-h UPE significantly decreased in the combined group. The 1 -year recurrence rate and the recurrence times decreased in the combined group （P 〈0.01 ）. The complete remission rate increased in the combined group （P 〈0.01 ）. Conclusion SD could effectively improve the clinical prognosis of PNS children patients possibly by reducing the release of inflammatory mediators such as CXCL16, ADAM10, and ADAM17, decreasing UPE and the TC level, and elevating the serum ALB level.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2014年第5期541-544,共4页
Chinese Journal of Integrated Traditional and Western Medicine
基金
福建省科技开发计划支助项目(No.2008KJB-09)
