雷公藤多苷治疗儿童重症紫癜性肾炎的临床观察

目的 观察雷公藤多苷治疗儿童重症紫癜性肾炎（HSPN）的有效性及安全性.方法 25例糖皮质激素治疗4周尿蛋白仍未转阴的重症HSPN患儿（年龄6~15岁）应用雷公藤多苷1 mg/（kg·d）,分次口服,疗程3～6个月.观察尿蛋白转阴时间及肾功能情况,并于雷公藤多苷治疗前、治疗1～2个月及停药后4周内动态观察血常规、肝肾功能、心肌酶、性激素及心电图的变化.结果 25例患儿中22例于用药4周内尿蛋白转阴,4~12周内转阴,1例用药15周时转阴,总有效率100%.雷公藤多苷治疗过程中及停药后血白细胞计数均值均较治疗前降低[（8.6±2.8）×109/L,（8.0±2.8）×109/L比（11.3±3.4）×109/L]（P〈0.05）;血红蛋白、血小板计数、心肌酶、肾功能指标治疗前后均在正常范围内,且差异均无统计学意义（均P〉0.05）.治疗过程中仅2例患儿出现丙氨酸氨基转移酶、天冬氨酸氨基转移酶轻度升高,停药后恢复正常;2例患儿出现心电图异常：1例左心室高电压,1例结性并行心律,停药后随访阶段恢复正常.未发现对血液、肾脏功能及对性激素水平的明显影响.结论 雷公藤多苷1 mg/（kg·d）、疗程3～6个月应用于儿童重症HSPN的治疗具有良好的疗效及安全性.

Clinical observation of tripterygium wilfordiipolyglycosidium treating children with severe henoch-schonlein purpura nephritis

Objective To observe the efficacy and security of tripterygium wilfordii polyglycosidium （TWP） treating children with severe henoch-schonlein purpura nephritis （HSPN）. Methods Twenty-five children failed with intravenous pulse methylprednisolone were given oral TWP for 3-6 months. The efficacy and security of TWP through examinations of urinalysis, blood routine, function of liver and renal, myocardial enzyme series, level of sex hormone and electrocardiogram （ECG） were evaluated before treatment, 1-2 month after giving TWP and 4 weeks after stopping medication, respectively. Results Proteinuria disappeared in all patients. The remission time was 4 weeks in 22 children, 12 weeks in 2 children, 15 weeks in 1 children respectively. Blood leukocyte count reduced after tripterygium wilfordii glycosides treatment compared with those before treatment[（8.6±2.8）×109/L,（8.0±2.8）×109/L vs （11.3±3.4）×109/L] （P〈0.05）. Hemoglobin, platelet count, myocardial enzymes and renal function indices were within the normal range before and after treatment, and there were no statistically significant differences （all P〉0.05）. During treatment, elevated glutamic-pyruvic transaminase and glutamic-oxaloacetic occurred in 2 patients and returned to normal after stopping medication. Abnormal findings in examination of ECG were observed in 2 patients： one with left ventricular high voltage and another with knot parallel rhythm of the heart. After stopping medication, the ECG of them returned to normal. There were no abnormalities of blood routine, renal function and level of sex hormone. Conclusion The TWP has good efficacy and security treating children with severe HSPN.