摘要
目的:观察犀角地黄汤联合雷公藤多苷片(GTW)治疗过敏性紫癜(Henoch-Sch nlein purpura,HSP)血热妄行证患者的临床疗效。方法:将中医辨证为血热妄行证的82例单纯皮肤型HSP患者随机分为犀角地黄汤组(中药组)40例、GTW组42例。中药组在西医常规治疗的基础上给予犀角地黄汤,GTW组在西医常规治疗的基础上给予GTW,两组均连续治疗8周。比较两组患者临床治愈率、皮疹缓解时间、皮肤紫癜复发次数及治疗前后中医证候积分、尿微量蛋白(microalbumin,M-Alb)、β2微球蛋白(β2-microglobulin,β2-Mb)、N-乙酰-β-D-氨基葡萄糖苷(N-acetyl-β-D-glucosaminidase,NAG)酶、血常规、肝肾功能及血清半乳糖缺陷型IgA1(Gd-IgA1)水平。随访至26周,评定GTW组临床疗效、肾脏保护作用及用药安全性;分析血清Gd-IgA1表达水平与临床症状的相关性。结果:治疗8周后,GTW组有效率、皮疹消退时间、HSP复发次数、中医证候积分、尿M-Alb、β2-MG、NAG酶及血清Gd-IgA1水平均明显优于中药组(P<0.05);与本组治疗前比较,GTW组上述血、尿检测指标均明显降低(P<0.05),中药组治疗后尿M-Alb、NAG酶显著高于治疗前(P<0.05);两组患者血红细胞、谷丙转氨酶、谷草转氨酶、肌酐水平比较,差异均无统计学意义(P>0.05),GTW组白细胞、血小板水平明显下降(P<0.05),但均在正常值范围内。治疗前82例患者血清Gd-IgA1表达量与中医证候积分有正相关关系,r=0.748;随访至26周,GTW组肾炎发生率显著低于中药组(P<0.05),发生时间明显延后(P<0.05)。结论:GTW可显著改善HSP患者的临床症状、降低皮肤紫癜复发率及紫癜性肾炎的发生率,有效预防肾脏损伤;其机制可能与降低过敏性紫癜患者血清Gd-IgA1表达水平而发挥肾脏保护作用有关。
Objective:To observe the clinical efficacy of Xijiao Dihuang Decoction combined with Tripterygium Glycosides Tablet(GTW)in treating patients with allergic purpura(Henoch-Schonlein purpura,HSP)of the blood-heat-wandering syndrome type.Methods:Eighty-two patients with simple skin-type allergic purpura diagnosed with blood-heat-wandering syndrome in traditional Chinese medicine were randomly divided into the Xijiao Dihuang Decoction group(TCM group,40 cases)and the GTW group(42 cases).The TCM group received Xijiao Dihuang Decoction in addition to conventional Western medical treatment,while the GTW group received GTW along with conventional Western treatment;both groups were treated continuously for 8 weeks.The clinical cure rate,rash remission time,recurrence frequency of skin purpura,and changes in TCM syndrome scores,urinary microalbumin(M-Alb),β2-microglobulin(β2-Mb),N-acetyl-β-D-glucosaminidase(NAG)enzyme,blood routine,liver and kidney function,and serum Gd-IgA1 levels before and after treatment were compared.Follow-up was conducted up to 26 weeks to evaluate the clinical efficacy,renal protection,and medication safety of the GTW group,and the correlation between serum Gd-IgA1 expression levels and clinical symptoms was analyzed.Results:After 8 weeks of treatment,compared with the Traditional Chinese Medicine(TCM)group,the GTW group showed significantly better outcomes in effective rate,rash resolution time,frequency of HSP recurrence,TCM syndrome scores,urine M-Alb,β2-MG,NAG enzyme,and serum Gd-IgA1 levels(P<0.05).Compared with pretreatment levels in the same group,the GTW group showed significant reductions in the aforementioned blood and urine indicators(P<0.05),whereas in the TCM group,post-treatment urine M-Alb and NAG enzyme levels were significantly higher than before treatment(P<0.05).Comparisons of red blood cells,ALT,AST,and creatinine levels between the two groups showed no statistically significant differences(P>0.05).White blood cell and platelet levels in the GTW group were significantly decreased(P<0.05),but remained within the normal range.Before treatment,serum Gd-IgA1 levels in 82 patients were positively correlated with TCM syndrome scores(r=0.748).At 26-week follow-up,the incidence of nephritis in the GTW group was significantly lower than in the TCM group(P<0.05),and the onset was significantly delayed(P<0.05).Conclusion:GTW can significantly improve clinical symptoms in HSP patients,reduce the recurrence of purpura and the incidence of purpura nephritis,and effectively prevent kidney damage.Its mechanism may be related to the reduction of serum Gd-IgA1 levels in patients with allergic purpura,thereby exerting a renal protective effect.
作者
宋丹
宋珂
陈瑶
宋凯敏
SONG Dan;SONG Ke;CHEN Yao;SONG Kaimin(Henan University of Chinese Medicine,Zhengzhou Henan China 450046;The First Affiliated Hospital to Henan University of Chinese Medicine,Zhengzhou Henan China 450009;The Affiliated Hospital to Hebei Engineering University,Handan Hebei China 056008;The Third Affiliated Hospital to Henan University of Chinese Medicine,Zhengzhou Henan China 450003)
出处
《中医学报》
2025年第12期2678-2684,共7页
Acta Chinese Medicine
基金
国家自然科学基金项目(82074493)
河南省中医药科学研究专项课题项目(2024ZY1002)
河南中医药大学2024年度研究生科研创新项目(2024KYCX058)。
关键词
过敏性紫癜
犀角地黄汤
雷公藤多苷片
血热妄行证
Henoch-Schonlein purpura
Xijiao Dihuang Decoction
Tripterygium Glycosides Tablet
