| Background:Henoch-Schonlein purpura (Henoch-Schonlein purpura, HSP) is one of the most common causes of systemic vasculitis in children. Henoch-Schonlein purpura nephritis (HSPN) is secondary to Henoch-Schonlein purpura (HSP). The incidence of HSP nephritis (HSPN) among HSP patients has been reported to be15-62%. HSPN is a glomerular disease that most commonly affects children, and its morbidity is only inferior to the nephrotic syndrome, acute nephritic syndrome and isolated hematuria among diseases of urinary system in Chinese children. Its number of inpatients accounts for approximately5.87percent of the Chinese inpatient children with diseases of urinary system during the same period. Proliferation of mesangial cell and stromal hyperplasia are the major manifestations of renal histopathologic changes of HSPN. Most of the children with HSPN have had a favorable prognosis after positive and correct treatment, but the progressive renal damage is still likely to occur in approximately1.0to15.7percent of children. The long-term prognosis largely depends on renal involvement. Some previous studies have described the treatment of severe HSPN with methyl-prednisolone and urokinase pulse therapy, cyclophosphamide, cyclosporine A, and other medications. Even though considering the side-effects of these medications and unfavorable prognosis of the present therapy strategy in some patients, it would be worth looking for the novel and more effective treatment for the present time.Triptolide is an effective principle of the Chinese traditional medicine Tripterygium wilfordii Hook F (TwHF) that has been widely used to treat rheumatoid arthritis, primary glomerulonephritis, and nephrotic syndrome for recent years. In the present study, clinical manifestation and long-term prognosis were evaluated in children with moderately severe HSPN manifested with nephrotic range proteinuria with normal kidney function and<50%crescents or sclerosing lesions receiving Triptolide therapy.Objective:To observe the clinical efficacy of the Chinese herb, Triptolide, in children with moderately severe Henoch-Schonlein purpura nephritis (HSPN).Methods:From January2007to December2011,56HSPN children manifested by nephrotic range proteinuria with normal kidney function and <50%crescents or sclerosing lesions on biopsy were hospitalized in the Children’s Hospital of Zhejiang University School of Medicine. They were divided into two groups:the treatment group (n=42; Triptolide at a dosage of lmg/kg·d, combined with prednisone at a dosage of2mg/kg·d, within a course of medium-to-long-term therapy of6to9months) and the control group (w=14; prednisone alone, with the same procedure).Both groups were given ACEi,in combination with Piperazine Ferulate Tablets and Radix Astragali for immunoregulation, loratadine for anti-anaphylactic and anti-infective treatment; curative effects and adverse reactions were observed. Observation indices included side-effects, short-term and long-term effects.Results:No significant difference was found in all indices (gender, age,.course, pathological type, urine protein quantification, serum albumin concentration, and serum creatinine (Scr)) between both groups.Short-term remission was observed in95%of patients from treatment group and in72%of patients from control group, respectively. There was a significant diference between both groups (χ2=6.222, P=0.029) for short-term effects. Meanwhile, no signiicant diference, as proteinuria, hematuria, hypertension, and decreased eGFR, was observed between the two groups in long-term followup (χ2=3.111, P=0.097). The Kaplan-Meier plot analysis also revealed no significant diference (χ2=2.633, P=0.105).Conclusion:Triptolide is effective in relieving short-term symptoms for moderately severe HSPN children, though its long-term effects need to be observed further. |
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