白芍总苷辅助治疗儿童紫癜性肾炎的疗效及其机制探讨：前瞻性随机对照研究

Clinical effect and mechanism of total glucosides of paeony in the adjuvant therapy for children with Henoch-Schönlein purpura nephritis: a prospective randomized controlled study

摘要:

目的 探讨白芍总苷（TGP）辅助治疗儿童紫癜性肾炎（HSPN）的临床疗效及其机制。方法 选取中度蛋白尿型HSPN患儿共64例，按随机数字表法分为TGP治疗组（TGP组，n=34）和常规治疗组（常规组，n=30），同期选取正常体检儿童30例作为健康对照组。两组患儿同时予常规治疗，观察组在常规治疗基础上加用TGP。比较两组患儿在治疗4周后的临床疗效，同时检测健康儿童及患儿外周血中滤泡辅助性T（Tfh）细胞比例及白细胞介素（IL）-21、IL-4水平，以及患儿血清胱抑素C（CysC）及尿α1微球蛋白（A1M）水平的变化。结果 HSPN患儿治疗前Tfh细胞比例及IL-21、IL-4表达水平较健康对照组明显升高（P < 0.01）。治疗后，TGP组的总有效率为94%，明显高于常规组（67%，P < 0.05）。两组患儿外周血中Tfh细胞比例及IL-21、IL-4水平，以及血清CysC、尿A1M水平均较治疗前有所下降，且TGP组患儿治疗后的上述指标较常规组患儿下降更为显著（P < 0.01）。结论 TGP治疗HSPN疗效显著，可能通过抑制Tfh细胞的增殖，下调IL-21、IL-4的表达，从而减轻肾脏炎症反应，起到保护肾脏的作用。

Abstract:

Objective To study the clinical effect and mechanism of total glucosides of paeony (TGP) in the adjuvant therapy for children with Henoch-Schönlein purpura nephritis (HSPN). Methods Sixty-four HSPN children with moderate proteinuria were divided into a TGP treatment group (n=34) and a routine treatment group (n=30) using a random number table. Thirty healthy children who underwent physical examination were enrolled as the healthy control group. The children in the routine treatment group were given conventional treatment alone, and those in the observation group were given TGP in addition to the conventional treatment. The two groups were compared in the clinical outcome after 4 weeks of treatment. The proportion of follicular helper T (Tfh) cells in peripheral blood and the plasma levels of interleukin-21 (IL-21) and interleukin-4 (IL-4) were measured in the healthy control group and the two HSPN groups. The changes in serum cystatin C (CysC) level and urinary alpha 1-microglobulin (A1M) concentration were compared before and after treatment in the two HSPN groups. Results Compared with the healthy children before treatment, the children with HSPN had higher proportion of Tfh cells and expression levels of IL-21 and IL-4 (P < 0.01). The TGP treatment group had a higher overall response rate to treatment than the routine treatment group (94% vs 67%, P < 0.05). After treatment, both groups had reductions in the proportion of Tfh cells in peripheral blood, the expression levels of IL-21, IL-4, serum CysC, and urinary A1M concentration. The TGP treatment group had greater reductions in these indices than the routine treatment group (P < 0.01). Conclusions TGP has a marked clinical effect in the treatment of HSPN and can reduce the inflammatory response of the kidney and exert a protective effect on the kidney by inhibiting the proliferation of Tfh cells and downregulating the expression of IL-21 and IL-4 in plasma.