Study On The Correlation Between Blood CysC, Urinary Kim-1 And Integrated Traditional Chinese And Western Medicine Step Scheme To Prevent Kidney Damage Of HSP

Objective: to study the renal damage of children with Henoch-Schonlein purpura after two treatment regimens and analyze the correlation between classification, clinical condition, dominal pain and kidney injury in step-treatment options.At the same time to explore clinical significance of blood Cys C,urine Kim-1 in early renal injury of HSP.Methods:(1)The research object and groups: according to the cohort study collecting 1010 cases of HSP which complyed with inclusion criteria from January 2014 to December 2014 including 731 cases of children in Henan Univercity of Traditional Chinese Medicine of first affiliated hospital as well as 279 cases in Children’s hospital of Zheng Zhou City.Based on the severity dividing the cases into light and severe by using the integral method(detailed appendix 1). Treatment scheme :the treatment of Chinese medicine hospital was option one,Children’s hospital group was option two.Specifically hospitalization treatment for 5~10 days:the light of option one:differentiation+Salvia Ligustrazine injection,the severe add to hormone(some cases used the tripterygium preparations); the light of option two: antiallergic drugs+Shuxuening injection,the severe add to hormone;Outpatient treatment for seven weeks: option one: TCM differential treatment etc; option two: Vitamin C, calcium carbonate D3 and so on.Withdrawal for four weeks.(2)Detection of indicator:①urine②24 hour urinary protein respectively in weeks 1,2,4,6 and 8 each week while detecting urine in 12 week;③blood Cys C,urine Kim-1 in 2th day of admission and 1 weeks of renal injury.Results:(1)The general situation of renal injury:the rate of renal damage after option one was 13.82%(101/731) and the rate of renal damage after option two was 18.64%(52/279).The appeareance had no significant difference(P>0.05);(2)The type of kidney damage: proteinuria, hematuria, proteinuria and hematuria was 23(22.77%), 46(45.54%), 32(31.68%) in types of renal injury after option one. Option two were 24(46.15%),16(30.77%),12(23.08%) respectively.The difference was not statistically significant(P>0.05);(3)The degree of renal injury: the light, medium and heavy were 51(50.5%), 40(39.60%),10(9.95%)after option one and 24(46.15%), 20(38.46%), 8(15.38%)after option two.The renal injury degree of light, moderate and severe had no significant difference in two groups(P>0.05);But there was significant difference between light+moderate and severe(P<0.05);(4)Renal injury time compare: Renal injury time after option one was 52.48±31.44 days.Option two was 40.39±27.18 days. There was statistically significant difference(P<0.05);(5)Stage of the disease and renal damage:the light, severe renal damage rates of the both were12.79%(78/610), 18.75%(75/400) and the difference was statistically significant(P<0.05);kidney injury rates of light and severe after option one was 12.31%(56/455),16.30%(45/276). There wasn’t significant difference(P>0.05);kidney injury rates of light and severe type after option two was 24.19(30/124)with significant difference(P<0.05).Compari- son of the same disease aftet two different teantment was not significant(P>0.05);(6) The clinical type and renal damage:on the whole renal injury rates of skin type,skin+joint type,skin+abdominal,skin+joint +abdominal was namely 11.16%(24/ 215), 12.16%(42/333),19.61%(41/209),18.18%(46/253).The difference was not statistically significant between skin type and skin+joint type(P>0.05).However there was significant difference between skin type and the latter two(P>0.05). After two treatment the difference between skin type and three type as well as the same type in two groups was not statistically significant(P>0.05);(7)Abdominal pain and renal damage: The whole renal injury incidence rate of the light,moderate and severe were 16.96%(38/224),37.38%(40/107) which was significant difference between the former and the latter two(P<0.05);specifically the renal injury incidence rate after option one were 4.67%(5/107),15.76%(29/184),42.37%(25/59) in which there was significant difference(P<0.05);option two was 16.67%(4/24),22.5%(9/40),31.25%(15/48) with no significant difference(P>0.05).(8)Laboratory marker:blood Cys C and urine Kim-1 weren’t statistically significant at the begining according to whether renal injury or not at the late course(P>0.05); blood Cys C, urine Kim-1 weren’t statistically significcant in different clinical classification(P>0.05); blood Cys C,urine Kim-1 weren’t statistically significant in different disease classification(P>0.05); blood Cys C, urine Kim-1 in HSP group which happened renal injury in the late progression between the early and the late stage was the statistically different(P<0.05).Conclusions:(1)The renal injury incidence rate after two option is lower than the those reported in the literature.It is suggested that the combination of TCM and Western medicine can effectively prevent renal damage of HSP.(2)Urine Kim-1 was involved in the renal injury of HSP.The change of Kim-1 and urine Cys C can reflect early renal damage of HSP.