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多慧玲, 梁燕, 吴笛, 魏华娟, 陈文军, 孙姗姗.活血化瘀汤加减联合他克莫司对过敏性紫癜性肾炎患者免疫因子、肾功能的影响[J].湖南中医药大学学报,2024,44(11):2049-2055[点击复制] |
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| 活血化瘀汤加减联合他克莫司对过敏性紫癜性肾炎患者免疫因子、肾功能的影响 |
| 多慧玲,梁燕,吴笛,魏华娟,陈文军,孙姗姗 |
| (石家庄市中医院肾病科, 河北 石家庄 050011) |
| 摘要: |
| 目的 探讨活血化瘀汤加减联合他克莫司对过敏性紫癜性肾炎风热夹瘀证患者免疫因子以及肾功能的影响。方法 本研究选取石家庄市中医院肾病科2023年1月至2024年2月收治的94例诊断为过敏性紫癜性肾炎风热夹瘀证的患者，采用随机数字表法分为对照组和观察组，各47例。对照组患者予他克莫司胶囊0.05 mg/（kg·d）治疗，餐前1 h口服，2次/d，间隔12 h；观察组在对照组基础上予活血化瘀汤加减治疗，2次/d。两组均连续治疗8周。比较对照组与观察组患者临床疗效、中医证候积分、免疫因子水平、肾功能、凝血功能及不良反应。结果 治疗前，两组患者中医证候积分、免疫因子、肾功能、凝血功能相比，差异无统计学意义（P>0.05）。治疗后，两组身热烦渴、水肿、尿血、皮肤紫斑、腹痛、微恶风寒评分及中医证候总积分、免疫球蛋白（immunoglobulin, Ig）A、IgM、T淋巴细胞分化抗原分子（T lymphocyte differentiation antigen molecule, CD）8+、红细胞计数（red blood cell, RBC）计数、胱抑素C（cystatin C, CysC）、尿素氮（urea nitrogen, BUN）、24小时尿蛋白定量（24 h urinary protein quantification, 24hUP）、β2-微球蛋白（β2-microglobulin, β2-MG）、血肌酐（serum creatinine, SCr）、血小板（platelet, PLT）计数、纤维蛋白原（fibrinogen, FIB）水平均较治疗前降低（P<0.05），IgG、CD4+、CD4+/CD8+、凝血酶时间（thrombin time, TT）、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、凝血酶原时间（prothrombin time, PT）水平均较治疗前升高（P<0.05）。与对照组比较，治疗后观察组中医证候积分、IgA、IgM、CD8+、RBC计数、24hUP、β2-MG、CysC、SCr、BUN、PLT计数、FIB水平均降低（P<0.01）；临床总有效率IgG、CD4+、CD4+/CD8+、TT、APPT、PT水平均升高（P<0.01）；观察组感染、头晕、恶心、消化道症状的发生率较对照组降低（P<0.05）。结论 活血化瘀汤加减联合他克莫司治疗过敏性紫癜性肾炎风热夹瘀证患者可提高临床疗效，改善患者免疫功能、凝血功能和肾功能。 |
| 关键词: 他克莫司 过敏性紫癜性肾炎 活血化瘀汤 肾功能 临床疗效 免疫功能 凝血功能 |
| DOI：10.3969/j.issn.1674－070X.2024.11.015 |
| 投稿时间：2024-05-29 |
| 基金项目:河北省中医药管理局中医药类科研计划课题（2020316）。 |
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| Effects of modified Huoxue Huayu Decoction combined with tacrolimus on immune factors and renal function in patients with Henoch-Schonlein purpura nephritis |
| DUO Huiling, LIANG Yan, WU Di, WEI Huajuan, CHEN Wenjun, SUN Shanshan |
| (Nephrology Department, Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang, Heibei 050011, China) |
| Abstract: |
| Objective To investigate the effects of modified Huoxue Huayu Decoction (HXHYD) combined with tacrolimus on immune factors and renal function in patients with Henoch-Schonlein purpura (HSP) nephritis of wind-heat and stasis pattern. Methods A total of 94 patients diagnosed with HSP nephritis of wind-heat and stasis pattern admitted to the Nephrology Department of Shijiazhuang Hospital of Traditional Chinese Medicine from January 2023 to February 2024 were selected and divided into control group and observation group by the random number table method, with 47 cases in each group. The control group received tacrolimus 0.05 mg/(kg·d) orally 1 h before meals, twice a day with a 12-h interval; the observation group was treated with modified HXHYD in addition to the treatment of control group, twice a day. Both groups were treated continuously for eight weeks. The clinical efficacy, Chinese medicine (CM) pattern scores, levels of immune factors, renal function, coagulation function, and adverse reactions were compared between the two groups. Results There were no significant differences in the CM pattern scores, levels of immune factors, renal function, and coagulation function between the two groups before treatment (P>0.05). After treatment, the scores for symptoms such as fever and thirst, edema, hematuria, cutaneous purpura, abdominal pain, slight aversion to wind and cold, as well as the CM pattern total score decreased in both groups. The levels of immunoglobulin A (IgA), immunoglobulin M (IgM), T lymphocyte differentiation antigen molecule 8+ (CD8+), red blood cell count (RBC), cystatin C (CysC), urea nitrogen (BUN), 24 h urinary protein quantification (24hUP), β2-microglobulin (β2-MG), serum creatinine (SCr), platelet count (PLT), and fibrinogen (FIB) were lower in both groups compared with those before treatment (P<0.05), while the levels of immunoglobulin G (IgG), T lymphocyte differentiation antigen molecules 4+ (CD4+), CD4+/CD8+, thrombin time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) were higher (P<0.05). After treatment, compared with the control group, the CM pattern scores and levels of IgA, IgM, CD8+, RBC, 24hUP, β2-MG, CysC, SCr, BUN, PLT, and FIB in the observation group were lower (P<0.05), while the total clinical effective rate and levels of IgG, CD4+, CD4+/CD8+, TT, APTT, and PT were higher (P<0.05). Additionally, the observation group exhibited a reduction in the incidence of infection, dizziness, nausea, and gastrointestinal symptoms (P<0.05). Conclusion The treatment with modified HXHYD combined with tacrolimus for the HSP nephritis of wind-heat and stasis pattern can enhance the clinical efficacy, and improve the immune function, coagulation function, and renal function of patients. |
| Key words: tacrolimus Henoch-Schonlein purpura nephritis Huoxue Huayu Decoction renal function clinical efficacy immune function coagulation function |
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