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目的:探讨健脾利湿补肾法对小儿肾病综合征(NS)骨代谢、体质量及生长发育的影响。方法:选取2012年6月—2014年6月医院收治的NS患儿66例作为研究对象,辨证为脾虚湿困型,采用随机数字表法分为对照组和观察组,各33例。对照组给予醋酸泼尼松片治疗,观察组在对照组基础上给予健脾化湿方治疗,4周为1个疗程,共治疗3个疗程。评估临床疗效,对主症状进行量化评分,检测血清白蛋白、24 h尿蛋白定量、血清骨钙素N端中分子片段(骨钙素N-MID)、骨钙素(BGP)、甲状腺旁激素(PTH)、骨特异性碱性磷酸酶(BALP);门诊和电话随访1年,了解两组身高和体质量(BMI)变化情况,记录复发率及复发次数。结果:观察组治疗有效率为93.94%,与对照组的84.85%比较,差异无统计学意义(P>0.05);观察组治疗后全身浮肿、面色萎黄、纳少便溏、乏力评分低于对照组(P<0.05);观察组治疗后血清白蛋白、骨钙素N-MID、BGP高于对照组,24 h蛋白定量、PTH、BALP低于对照组。两组治疗后1年身高、BMI较治疗前升高(P<0.05),但治疗后1年组间比较无差异(P>0.05);观察组1年复发率为21.21%明显低于对照组的48.48%(P<0.05);观察组1年平均复发次数少于对照组(P<0.05)。结论:健脾利湿补肾法辅助治疗小儿NS可有效缓解临床症状,改善骨代谢异常,但对患儿生长发育无明显影响。
Objective: To investigate the effects of invigorating the spleen, dampness and tonifying kidney on bone metabolism, body weight and growth in children with nephrotic syndrome (NS). Methods: Sixty-six children with NS who were admitted to our hospital from June 2012 to June 2014 were selected as the study objects. The syndrome differentiation was spleen deficiency and wetness syndrome. The patients were divided into control group and observation group by random number table. The control group was treated with prednisone acetate. The observation group was given Jianpi Huashi Decoction on the basis of the control group. One course of treatment was 4 weeks, a total of 3 courses of treatment. The curative effect was evaluated and the main symptoms were quantified. Serum albumin, 24 h urinary protein, serum N-terminal osteocalcin (osteocalcin N-MID), BGP, thyroid hormone (PTH) and bone specific alkaline phosphatase (BALP). Outpatients and telephone were followed up for 1 year to understand the changes of height and body mass (BMI) in both groups. The recurrence rate and recurrence frequency were recorded. Results: The effective rate of observation group was 93.94%, compared with 84.85% of the control group, the difference was not statistically significant (P> 0.05); the observation group had edema, pale complexion, (P <0.05). Serum albumin, osteocalcin N-MID and BGP in the observation group were higher than those in the control group after 24 h of treatment. The protein content of 24 h and the levels of PTH and BALP in the observation group were lower than those in the control group. The height and BMI of the two groups after treatment were significantly higher than those before treatment (P <0.05), but there was no difference between the two groups (P> 0.05). The one-year recurrence rate was 21.21% in the observation group, which was significantly lower than that in the control group 48.48% (P <0.05). The average number of recurrence in observation group was less than that in control group (P <0.05). Conclusion: The adjuvant therapy of invigorating the spleen and dampness and tonifying the kidney can effectively relieve the clinical symptoms and improve the abnormal bone metabolism, but it has no obvious effect on the growth and development of children.