Chinese and western medicine combined with 32 cases of allergic purpura nephritis
Allergic purpura nephritis is a set of allergy caused by extensive capillary inflammation as the main pathological basis of clinical syndrome, is a common secondary glomerulonephritis. The clinical manifestation of the skin purpura, clocking, the pain, abdominal pain, and blood, the common blood urine, proteinuria, the general prognosis is good. But a number of cases have often been repeated and delayed, and eventually developed into kidney failure. We have received a certain result in clinical use of Chinese and western medicine, the summary is summarized below.
The general information
Of the 52 cases, 24 were men and 28 were women. Age 6 ~ 41 years old; average age 19; From 1 to 36 months, 6 months on average; There were 46 cases of skin purpura in the skin, 20 cases of joint pain and 23 abdominal pain. There were only 25 cases of urine and proteinuria after the withdrawal of renal disease. Kidney damage is shown in 34 cases of erythropoiesis and proteinuria; 10 cases of pure red blood cells, 8 cases of pure albuminuria. They were randomly pided into two groups, including 32 in the treatment group and 20 in the control group. The two groups were not significantly different in age, sex, disease and clinical performance.
Inclusion criteria: selected cases in accordance with the 2000 pediatric branch of Chinese medical association kidney disease group statistical revision of purpura nephritis diagnostic criteria: (1) in the course of allergic purpura presenting with macroscopic haematuria and microscopic haematuria and (or) proteinuria or tube type urine; It may be accompanied by abdominal pain, swelling in joints and joints, pain and pain, etc. Platelet count, bleeding and coagulation time, blood clotting factors were normal, white blood cells were normal or slightly elevated, or eosinophils increased.
The treatment group was treated with western medicine and the control group was treated only with western medicine. The observation was six months.
General treatment: acute periods of bed rest, preventing colds. Avoid foods such as raw protein, such as protein, protein, etc. Pay attention to nutrition and keep the water electrolyte balance. The gastrointestinal bleeding can be temporarily fast or semi-liquid.
Western medical treatment: when there is a clear infection and infection, antibiotic treatment should be given. Antiallergic treatment: antihistamine, vitamin C, cimetidine; Anticoagulation: dipyridamo, dantin; The ACEI drugs (such as benapelle); The disease is mild, mild, moderate and severe. Light: purpura, hematuria in the mirror, a small amount of proteinuria. Oral prednisone 5 ~ 1.0 mg/d, reduced to 10mg/kg (kg d) by 4 to 8 weeks. It can also be taken with a tablet of thunder and vine. Moderate: purpura is serious, a lot of hematuria and proteinuria, or have hypertension, methyl prednisolone o. 5 g intravenous drip, 1 times a day, stay 3 days, then the oral prednisone o. 5 ~ 1.0 mg/(kg · d), take 4 ~ 8 weeks after gradually reduced to 10 mg/d. You can also take a thunder vine. Severe: the naked eye hematuria, proteinuria, high blood pressure, kidney damage, on the basis of moderate treatment plus cyclophosphamide o. 4 g/time, static drop, 2 times a month, application after 3 months instead of once per month, total amount is less than 8 g.
Traditional Chinese medicine: three phases and five types. Early on: the heat of the wind makes the lungs, the complex veins are damaged: the initial appearance of the foreign image, purpura, urine blood. It is advisable to remove heat from the air and to cool blood. Silver flower 15 g, forsythia, 15g, light bamboo leaves 9g, wormwort 9g, raw ground 15g, peony skin 9g, white mouten 25g, cicada slough 6g, red peony 9g, purple grass 9g. Medium: hot poison is in the heat, forced blood to act: the disease is heavier, the purpura is serious, the bleeding tendency is obvious. The cure should heat detoxify and cool blood. When rhino horn to close field thistle YinZi add and subtract: buffalo horn 30 g, radix rehmanniae 20 g, red paeony root, 10 g, cortex moutan, 9 g, 20 g, field thistle mountain gardenia 9 g, lophatherum gracile 9 g, 9 g angelica, Fried cattail pollen 9 g, lotus root section 9 g, talc 15 g. The heat and humidity of the veins: purpura, haemorrhage, and the thickening of the tongue. The cure is hot and dry and the blood stasis. Three benevolence tonga subtraction: almond 9 g, 6 g white Chloe benevolence (after), semen coicis 20 g, 10 g magnolia bark, pinellia 10 g, lophatherum gracile 9 g, cortex phellodendri, 9 g, 9 g, rhizoma atractylodis, radix cyathulae 9 g, rhizoma anemarrhenae, 9 g, red paeony root, 10 g, Oriental arborvitae 15 g. Later: the liver kidney is Yin and void, the inflammation of the mouth is inflamed: the purpura is receding, the mouth is dry and the mouth is dry, the mirror is hematuria, the tongue is red and the mossy. The cure should nourish the liver and kidney, cool blood to disperse stasis. It is 15 g, 15 g of yam, 12 g of dogwood, 9 g for peony, 9 g for the peony, 9 g for poria, 12 g for the mother, 9 g for the mother, 9 g for the mother, and 15g for the herb, and 15g for the dry lotus grass, and 10g for the white mag root. The spleen and kidney are two empty, and the water is in wet: the purpura recede, the weak, the bloated, the large amount of proteinuria. It is suitable for the healthy and invigorating spleen and kidney. Real wu-tang jia-tang plus or minus: poria, 20g, white art 15g, paeonia 10g, 6g, astragalus 20g, 10g of the party, 10g, 9g, 30g, ginger root, 9g, and 6g. The above medicine daily 1 dose, the water decoction suit, the morning and evening each one. The amount of children's medicine decreased.
Observation indicators: symptoms and signs of clinical symptoms: postural symptoms, skin purpura, joint pain, abdominal pain, blood pressure, edema; (2) laboratory indicators: check before and after the treatment, routine urine and blood quantitative 24 h urine protein, urine red blood cell quantity, serum creatinine, prothrombin time, blood fibrinogen and other indicators.
Statistical methods, experimental data, (x (-) -plus or minus s), the comparison of the groups with t, and P < o. 05 for statistical differences.
The treatment results
Outcome standards: complete remission: edema, renal hypertension and other symptoms and signs disappeared completely, proteinuria continued negative, red B cells continued negative urine, urine protein quantitative < o. 2 g / 24 h, normal serum creatinine. Basic relief: the symptoms and signs are almost gone, the albuminuria continues to reduce > 50%, the urine red blood cells are normal, and the blood creatine is normal or high. No relief: no improvement in clinical performance and laboratory examination.
The clinical efficacy was compared to table 1.
The clinical outcomes of table 1 were compared (example)
A complete reduction in the total reduction of the group number (%).
The control group was 20, 6, 7, 765.0%
The treatment group was 32, 13, 16, 390.6%
The treatment group was more effective than the control group, and the overall effectiveness was statistically significant (P < 0.05).
Allergic purpura nephritis is a secondary disease of secondary glomerulus, which is more common in clinic. The main pathogenesis as allergens, such as food, drugs, bacteria and toxins, etc.) cause the formation of immune complex, inducing immunity injury and vascular systemic small vasculitis, hemal wall damage, permeability increases, blood lymphatic leakage, cause skin mucous membrane, produce allergy in areas such as the internal organs. Research shows that allergic purpura nephritis is a kind of immune complex diseases, to detect the circulating immune complex in serum, skin small blood vessels and glomerular, mesenteric vascular hypersensitivity vasculitis lesions; Lesion blood vessel and glomerular IgA, C3 granular could be calm and immune complex deposition in the capillary wall caused by glomerular capillary inflammation and thrombosis, produce kidney disease.
According to the clinical manifestations of allergic purpura nephritis, it is characterized by "macula", "urine blood" and "urine turbidity". The formation of this disease, due to the loss of air and the Yin, is a great evil, an invasion of the evil spirits (mainly the evil of wind and heat). Evil heat enters the blood, disturbed the blood, forced blood to line, the outside overflows the skin to see the purpura, the inside of the kidney and the urine blood, the wound and the intestines and the blood. According to the change of course, the disease is pided into three phases. Stage 3: early, middle and late. Type 5: the air heat, the heat and the heat, the heat, the heat, the heat, the moisture, the liver, the spleen and the kidney. In the early days: wind and heat of the lungs: the disease of the wind and heat, and the damage and the hemorrhage of the blood. Medium-term: toxic heat flourishing: known as the internal accumulation of toxic heat wind hot muscle, blood, people camp forced blood jump line, overflow in muscle, skin purpura, burns renal collaterals and bladder blood and nixie; Heat and humidity: the heat of the inside and the heat of the wind, the removal of the kidney and the bladder and the urine. Later: the liver and kidneys are evil: sick and evil days and the Yin of the liver and kidney, the disease is caused by real turning, the Yin and the fire, the burning of the kidney and the blood in the kidney. Spleen kidney deficiency: disease for a long time and a Yang, spleen and kidney Yang deficiency can't gas lines of water, the water in the wet, edema, human have no right to, subtle leakage, appeared a lot of proteinuria. Allergic purpura nephritis with lung, spleen, kidney three dirty dysfunctional, "its mark in the lungs, its in the kidney, the system in the spleen, heat, wet, poison, blood stasis, deficiency is the main pathogenesis, blood stasis often throughout the course of the disease.
In recent years, there has been a recognition of the progress of the angiotensin one aldosterone system in purpura nephritis, and the study of the gene polymorphism in ACE is also taken seriously. The ACEI (angiotensin-converting enzyme inhibitors) and ARB (angiotensin receptor blockers) has been widely used in clinical, in reducing urinary protein, control of blood pressure, protect kidney function and delay chronic progress has a positive role. Other studies have suggested the obstacles in the glomerular capillary blood coagulation and fibrinolysis is one of the decisive factors in forming glomerulonephritis irreversible lesions, which can lead to kidney tissue damage and renal impairment, and anticoagulant therapy help to improve the renal pathological damage, block to the development of chronic, promote restoration of the glomerular injury. Chinese traditional Chinese medicine and blood stasis are helpful to improve the circulation of blood circulation in the kidney, and the treatment of Chinese traditional Chinese medicine on the basis of syndromes is obviously curative.