Clinical Efficacy on Addition and Subtraction Therapy of Zhibai Dihuangwan Combined with Wulingsan on Children with Refractory Nephrotic Syndrome / 中国实验方剂学杂志

ABSTRACT

Objective:This study aims to investigate the clinical effect of addition and subtraction therapy of Zhibai Dihuangwan combined with Wulingsan in the treatment of refractory nephrotic syndrome （RNS） with Yin deficiency of liver and kidney and its regulatory effect on immune inflammatory response. Method:In this study， 108 children were randomly divided into observation group （54 cases） and control group （54 cases）. Patients in two groups were treated with prednisone acetate tablets combined with tacrolimus capsules . Patients in control group took Liuwei Dihuang oral liquid， 5-10 mL/time， twice a day. Patients in control group were prescribed the addition and subtraction therapy of Zhibai Dihuangwan combined with Wulingsan， 1 dose/day. The course of treatment for both groups was 6 months. The 24 h urine total protein （24 h-UTP）， serum albumin （ALB）， serum creatinine （Scr）， blood urea nitrogen （BUN）， total cholesterol （TC）， triglyceride （TG）， low density lipoprotein （LDL）， high density lipoprotein （HDL）， liver and kidney Yin deficiency syndrome score， fibrinogen （FIB）， <italic>D</italic>-dimer （<italic>D</italic>-D）， prothrombin time （PT） and activated partial thromboplastin time （APTT） were compared before and after treatment. Also， tumor necrosis factor-<italic>α</italic> （TNF- <italic>α</italic>）， interleukin-6（IL-6）， IL-10， IL-17， CD4⁺ and CD8⁺， helper T lymphocytes17 （Th17）， regulatory T cell （Treg） were detected before and after treatment， and CD4⁺/CD8⁺andTh17/Treg were also calculated. Result:The levels of 24 h-UTP， TC， TG， LDL， FIB， <italic>D</italic>-D， TNF-<italic>α</italic>， IL-10， IL-6 and IL-17 in observation group were all lower than those in control group （<italic>P</italic><0.01）， and the levels of CD8⁺， Th17 and Th17/Treg were alsolower than those in control group （<italic>P</italic><0.05）. While the levels of HDL，ALB， CD4⁺， Treg and CD4⁺/CD8⁺ in observation group were higher than those in control group （<italic>P</italic><0.05）. The comprehensive efficacy in observation group was better than that in control group （<italic>Z</italic>=2.02， <italic>P</italic><0.05）， and the traditional Chinese medicine （TCM） syndrome efficacy of observation group was better than that of control group （<italic>Z</italic>=2.10， <italic>P</italic><0.05）. Conclusion:Based on the treatment of hormone combined with Tacrolimus， Zhibai Dihuangwan combined with Wulingsan can reduce urinary protein， improve lipid metabolism disorder and hypercoagulability， and regulate immune inflammatory reaction in patients with RNS and Yin deficiency of liver and kidney， with remarkable comprehensive effect and TCM syndrome effect.