【作者】 王娜；

【导师】 张东风；

【作者基本信息】 河北医科大学 ， 儿科学， 2012， 硕士

【摘要】 目的：过敏性紫癜性肾炎（HSPN）是我国儿童时期常见的继发性肾小球疾病之一，且其发病率有逐年增加的趋势。其发病机制主要涉及到免疫系统紊乱，同时有细胞因子与炎症介质的参与，凝血与纤溶紊乱以及基因多态性改变也发挥着重要作用。本研究观察具有免疫调节作用、滋肾润肺补肝等功能的槐杞黄颗粒对HSPN患儿的血清T细胞亚群（CD3+、CD4+、CD8+以及CD4/CD8+）、尿肾损伤分子-1（Kim-1）及尿P选择素的影响，从而了解槐杞黄颗粒是否对过敏性紫癜性肾患儿的免疫功能、细胞因子及凝血系统等方面均有调节作用。方法：1研究对象及实验分组：选择2010年11月至2011年10月在我院小儿肾脏内科住院的符合目前国内制定的HSPN诊断标准(2000年,珠海)的患儿54例，其中男35例，女19例，年龄3-14岁，根据HSPN的临床表现分为：A组即少量蛋白尿和（或）血尿组，B组即大量蛋白尿组（大量蛋白尿即24小时尿蛋白定量≥50mg/kg）。将A组、B组按照随机原则分别分A1（16例，男10例，女6例，平均年龄7.6岁）、B1（10例，男7例，女3例，平均年龄8岁）为治疗组，A2（18例，男11例，女7例，平均年龄7.4岁）、B2（10例，男7例，女3例，平均年龄7.9岁）为对照组。均为初治患儿，入院前未应用激素及其它免疫抑制剂，除外入院前两周曾用过肾毒性药物者及各种原因引起的急慢性肾功能损害患儿。入院后A、B两组均给予常规治疗（包括泼尼松、维生素C、芦丁、强溢、迪巧、肾炎康复片、抗感染等），在此基础上，治疗组加用槐杞黄颗粒，小于3岁，5g bid；大于3岁，10g bid；疗程1个月。另设健康组15例，其中男7例，女8例，平均年龄6.8岁。选择同期门诊年龄、性别相匹配的健康体检儿童，无风湿、哮喘病史。2检测指标及实验方法：采用流式细胞术测定T淋巴细胞亚群，用双抗体夹心ABC-ELISA法测尿P选择素和尿肾损伤分子-1的表达。各种指标分别于入院后常规用药治疗前和用药一个月之后检测。所得数据采用SPSS13.0统计分析软件进行统计学处理，采用均数±标准差表示，临床资料各组间统计学方法为t检验和方差分析，以P<0.05代表有显著差异，P>0.05为无显著差异。结果：1A组、B组及健康组T细胞亚群测定值的比较1.1A1、A2两组患儿治疗前CD3+、CD4+、CD8+与CD4/8+比较，差异无统计学意义(P>0.05)。A1、A2两组治疗前与健康组比较，CD3+、CD4+差异均有统计学意义(P<0.05)。两组治疗前后CD4+比较，差异有统计学意义(P<0.05);两组治疗后比较,改善CD4+方面,治疗组优于对照组(P<0.05)。A1组治疗后与健康组比较，CD3+、CD4+、CD8+与CD4/8+差异均无统计学意义(P>0.05)，而A2组治疗后与健康组比较，CD3+、CD4+差异仍有统计学意义(P<0.05)。可见治疗组在改善血清CD3+、CD4+方面优于对照组。1.2B1、B2两组患儿治疗前CD3+、CD4+、CD8+与CD4/8+比较，差异无统计学意义(P>0.05)。B1、B2两组治疗前与健康组比较，CD3+、CD4+、CD8+与CD4/8+差异均有统计学意义(P<0.05)。两组治疗前后CD3+、CD8+比较，差异有统计学意义(P<0.05)；两组治疗后比较,改善CD3+、CD8+方面，治疗组优于对照组(P<0.05)。2A组、B组患儿尿肾损伤分子-1（Kim-1）测定值的比较2.1A1、A2两组患儿治疗前尿Kim-1数值无统计学意义(P>0.05)。这两组患儿治疗后与治疗前相比，尿Kim-1数值均明显降低，差异有统计学意义(P<0.05)；这两组患儿治疗后尿Kim-1数值相比，A1组在降低尿Kim-1方面,优于A2组(P<0.05)。2.2B1、B2两组患儿治疗前尿Kim-1数值无统计学意义(P>0.05)。这两组患儿治疗后与治疗前比较，尿Kim-1数值均明显降低，差异有统计学意义(P<0.05)；这两组患儿治疗后尿Kim-1测定值相比较，在保护肾脏方面，B1组优于B2组(P<0.05)。3A组、B组患儿尿P选择素测定值的比较3.1A1、A2两组患儿治疗前尿P选择素数值无统计学意义(P>0.05)。这两组患儿治疗后与治疗前相比，尿P选择素数值均下降，差异有统计学意义(P<0.05)；这两组患儿治疗后尿P选择素测定值相比较，无统计学意义(P>0.05)。3.2B1、B2两组患儿治疗前尿P选择素数值无统计学意义(P>0.05)。这两组患儿治疗后与治疗前比较，尿P选择素数值均降低，差异有统计学意义(P<0.05)；这两组患儿治疗后尿P选择素测定值相比较，在活血方面，两组无明显差异(P>0.05)。结论：过敏性紫癜性肾炎患儿治疗前存在T细胞免疫功能降低、紊乱，凝血与纤溶紊乱及肾脏损害。槐杞黄颗粒不但能明显改善T细胞免疫功能紊乱，还具有保护肾脏的作用，但对于改善凝血与纤溶紊乱作用不明显。槐杞黄颗粒副作用甚微，可作为HSPN治疗的辅助药物。更多还原

【Abstract】 Objective: Henoch-schonlein purpura nephritis is one of commonsecondary glomerular diseases in children period, and its incidence isincreasing year by year. Its incidence mechanism mainly involves immunesystem disorders, and at the same time have cell factors and inflammation inthe blood coagulation and fibrinolytic disorders and gene polymorphismchange also plays an important role. This study observes that having immuneadjustment function and liver kidney embellish lung function of Huaiqihuanggranules influence on children HSPN serum T cells subsets (CD3+, CD4+,CD8+and CD4/CD8+), urine Renal Injury Molecules-1(Kim-1) and urinesP-Selectin, and to learn whether Huaiqihuang granules could regulatechildren’s immune function, cell factors and coagulation system..Methods:1the research object and the experimental group: Choose in November2010to October2011pediatric renal medicine in our hospital in accord with thecurrent domestic HSPN formulated diagnostic criteria (2000, zhuhai) ofchildren of54, the male35patients, female19cases, aged3to14years old,HSPN according to the clinical manifestations of divided into: group A issmall proteinuria and (or) hematuria,group B is a lot of proteinuria. Group Aand group B respectively in accordance with the principle of random pointsA1(16cases, male, female,10cases of6cases, mean age7.6years), B1(10cases, male in7cases,3cases of female, with an average age of8years old)for the treatment group, A2(18cases, male, female11cases in7cases, meanage7.4years), B2(10cases, male in7cases,3cases of female, mean age7.9years) as control group. For children are treated first, prior to admissionapplication hormone and other immune inhibitors, except two weeks prior toadmission once used kidney drug toxicity and all kinds of the causes of acute or chronic renal damage children. After admission of A and B both groups toconventional therapy (including prednisone, vitamin C, rutin, strong overflow,dean of chocolate, and nephritis, resistance to infection and recovery), basedon this, the treatment group add with Huaiqihuang granules, less than3yearsold,5g bid; More than3years old,10g bid; Treatment a month. Another setof health in15cases, the male in7cases,8cases of female, with an averageage of6.8years. The same period choose outpatient age, gender matched thehealthy check-up of children, no rheumatism, asthma history.2test index and experimental methods: The operation flow cytometrydetermination T cells subsets, with double antibody sandwich ABC-ELISAmeasuring element and urine urine P choice of kidney injury molecules-1expression. Detection all kinds of index before conventional medicine andafter a month of treatment. The data from the statistical analysis softwareSPSS13.0statistical treatment, and a mean±standard deviation said, clinicaldata between the statistical methods for t test and analysis of variance, P <0.05represents a significant difference, P>0.05for no significant difference.Results:1The comparison of T cells subsets determination values in group A, group Band health group.1.1The comparison of before treatment CD3+, CD4+, CD8+and CD4/CD8+in group A1and group A2, the difference was not statistically significant(P>0.05). Group A1and group A2before treatment compared with healthygroup, the differences of CD3+, CD4+are statistically significant (P<0.05). Inthe group A1and group A2, CD4+determination value before and aftertreatment, the difference was statistically significant (P<0.05); The two groupsafter treating comparison, improve CD4+aspects, the treatment group than incontrol group (P<0.05). Group A1after treatment compared with health group,the difference of CD3+, CD4+, CD8+and CD4/CD8+were not statisticallysignificant (P>0.05), and group A2after treatment compared with healthgroup, CD3+, CD4+still have statistically significant (P<0.05). Visiblely,treatment group improve serum CD3+, CD4+better than the control group. 1.2The comparison of before treatment CD3+, CD4+, CD8+and CD4/CD8+in group B1and group B2, the difference was not statistically significant(P>0.05). Group B1and group B2before treatment compared with healthygroup, the differences of CD3+, CD4+, CD8+and CD4/CD8+are statisticallysignificant (P<0.05). In the group B1and group B2, CD3+,CD8+determination value before and after treatment, the difference was statisticallysignificant (P<0.05); the comparison of group B1and group B2after treating,the treatment group better than in control group in improving CD3+,CD8+aspects(P <0.05).2The comparison of urine Renal Injury Molecules-1(Kim-1) determinationvalues in group A,and group B.2.1The determination values of urine Kim-1before treatment are notstatistically significant in group A1and group A2(P>0.05). These two groupsof children after treatment compared with before treatment, urine Kim-1numerical are reducing significantly, and difference is statisticallysignificant(P<0.05); the comparison of urine Kim-1numerical after treatment,group A1in reduncing urine Kim-1better than group A2.(P<0.05).2.2The determination values of urine Kim-1before treatment are notstatistically significant in group B1and group B2(P>0.05). These two groupsof children after treatment compared with before treatment, urine Kim-1numerical are reducing significantly, and difference is statisticallysignificant(P<0.05); the comparison of urine Kim-1numerical after treatment,group B1in reduncing urine Kim-1better than group B2.(P<0.05).3The comparison of urine sP-Selectin determination values in group A,andgroup B.3.1The determination values of urine sP-Selectin before treatment are notstatistically significant in group A1and group A2(P>0.05). These two groupsof children after treatment compared with before treatment, urine sP-Selectinnumerical are reducing significantly, and difference is statisticallysignificant(P<0.05); the comparison of urine sP-Selectin numerical aftertreatment, group A1and group A2are not statistically significant(P>0.05). 3.2The determination values of urine sP-Selectin before treatment are notstatistically significant in group B1and group B2(P>0.05). These two groupsof children after treatment compared with before treatment, urine sP-Selectinnumerical are reducing significantly, and difference is statisticallysignificant(P<0.05); the comparison of urine sP-Selectin numerical aftertreatment, group B1and group B2are not statistically significant(P>0.05).Conclusion: Henoch-schonlein purpura nephritis exist T cells reduced, andthe immune function disorder, blood coagulation and fibrinolytic disorders andkidney damage. Huaiqihuang granules not only can improve the T cellsimmune function disorder, also has to protect the function of kidney, but toimprove blood coagulation and fibrinolytic disorder effect is not obviously.Huaiqihuang granules have little side effects, and it can be used as a treatmentfor the HSPN computer-aided drug.更多还原