摘要
目的探讨白芍总苷(TGP)治疗单纯蛋白尿型紫癜性肾炎(SPPN)的临床疗效及对血浆中白细胞介素33(IL-33)、可溶性人基质裂解素2(s ST2)表达的影响。方法选取2016年6月至2017年6月徐州医科大学附属医院收治的61例SPPN患儿为研究对象,依据随机数字法分为对照组和观察组。对照组33例,给予醋酸泼尼松片口服及常规治疗;观察组28例,在醋酸泼尼松片口服及常规治疗的基础上加用TGP,两组均进行3个月的治疗并随访6个月。检测两组患者治疗前、治疗后2周、4周血浆IL-33、s ST2水平及24 h尿蛋白定量(24 h-UPRO)、尿α1微球蛋白(α1-MG)、尿转铁蛋白(TFRU)水平变化,并观察随访6个月内皮疹反复次数、初次尿蛋白转阴时间、蛋白尿反复次数。结果观察组总有效率高于对照组[89.3%(25/28)比57.6%(19/33)](P<0.05)。对照组IL-33、s ST2在治疗2周时下降不明显,4周时表达量显著下降(P<0.05);观察组IL-33、s ST2治疗2周、4周时均下降,4周时下降更显著(P<0.05);两组IL-33、s ST2组间、不同时点间、组间和不同时点间比较差异均有统计学意义(P<0.01)。对照组24 h-UPRO、α1-MG在治疗2周时下降不明显,TFRU在治疗2周时升高,4周时表达量均显著下降(P<0.05);观察组治疗2周、4周时24 h-UPRO、α1-MG、TFRU均下降,4周时下降更显著(P<0.05);两组24 h-UPRO、α1-MG、TFRU不同时点比较,以观察组下降更明显(P<0.05)。随访6个月内,观察组皮肤紫癜反复次数、蛋白尿反复次数较对照组明显减少(P<0.01);初次尿蛋白转阴时间较对照组明显缩短(P<0.01)。结论SPPN患儿存在明显的血浆IL-33、s ST2水平升高,TGP能在一定程度上下调IL-33、s ST2表达,减轻SPPN患儿蛋白尿,延缓肾脏损伤,改善患儿临床症状。
Objective To explore the effect of herbaceous total glucosides of paeony（ TGP） on simple proteinuria purpura nephritis（ SPPN） and the expression of plasma interleukin-33（ IL-33）,soluble suppression of tumorigenicity 2（ s ST2）. Methods From Jun. 2016 to Jun. 2017,61 patients suffering from SPPN admitted to Xuzhou Medical University Affiliated Hospital were included in the study and randomly divided into two groups,a control group and an observation group according to random number method. The control group of 33 patients was given prednisone acetate tablets oral and conventional therapy; the observation group of 28 cases was treated by TGP on the basis of prednisone oral and conventional therapy,and both groups were treated for 3 months and followed up for 6 months. The level of IL-33,s ST2,24 hour urinary protein quantity（ 24 h-UPRO）,alpha1-microglobulin（ α1-MG）,urinary transferrin（ TFRU） of the two groups before treatment,2 weeks,4 weeks after treatment were detected; the repeated times of skin purpura,the conversion time of initial proteinuria and the repeated number of proteinuria in the follow-up period of 6 months were observed. Results The total effective rate of the observation group was higher than that of the control group [89. 3%（ 25/28） vs 57. 6%（ 19/33） ]（ P〈0. 05）. The decrease of IL-33,s ST2 in the control group was not obvious after 2 weeks of treatment,and the expression after4 weeks of treatment decreased significantly（ P〈0. 05）. In the observation group,IL-33,s ST2 decreased after 2 weeks and4 weeks of treatment,and the decrease at 4 weeks was more obvious（ P〈0. 05）. There were statistically significant differences in IL-33 and s ST2 between the two groups,between different time points,between groups and different time points（ P〈0. 01）. The decrease of 24 h-UPRO,α1-MG in the control group was not obvious after 2 weeks of treatment,but TFRU increased after 2 weeks of treatment,but decreased significantly after 4 weeks of treatment（ P
作者
李艳佳
董晨
关凤军
LI Yanjia;DONG Chen;GUAN Fengjun(Department of Pediatrics,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《医学综述》
2018年第16期3293-3298,共6页
Medical Recapitulate
