| ObjectiveThrough the retrospectively study of medical records of hospitalized children with systemic lupus erythematosus (SLE) in our hospital from 2003 to 2015, analyzing the clinical characteristics and treatment of traditional Chinese medicine(TCM) and western medicine, and summarizing the clinical experience, in order to provide reference and mirror for the standardized treatment of integrated traditional and western medicine for the children with SLE.MethodsCollecting and collating medical records of hospitalized children with SLE in Guangdong Provincial Hospital from 2003 to 2015, making statistical analysis from general information, first symptom, clinical manifestations, complications, tongue and pulse syndromes of TCM, diagnosis and treatment of traditional Chinese and Western medicine, and prognosis of disease etc, analyzing the predisposing factors and the use of hormones and other drugs in repeated hospitalized children, and summarizing the clinical diagnosis and treatment experience of traditional Chinese and western medicine in children with SLE.Results1.Participants included 45 cases, male female ratio was 1:8.01, and the average age was 11.49±2.01 years old. The first symptom usually expressed as rash, fever, joint pain, edema. Fatigue, facial redness or rash, face or limbs edema, cough, sputum, fever, dry mouth, foam in urine, abdominal pain and distension, joint pain or swelling, hair loss, loss of appetite are the main symptom of SLE in children, and the improvement in varying degrees after treatment. Misdiagnosis rate was 57.14%before admission and 24 cases were diagnosed clearly after admission. Lupus nephritis, respiratory infection, blood cell reduction are the most common complications of SLE in children, 64.44%of children were concurrent with lupus nephritis,38.10%pathological type expressed as IV type.In laboratory examination, the positive rates of ANA, dsDNA were the highest in autoantibody tests; C3 reduce were main expressed in immunological indexes; Hemoglobin and red blood cells reduced most in routine blood clues; ESR increased most in flammation index; Albuminuria and cruenturesis were the most common expressions in urine convention. According to the SLEDAI score table, the disease activity of SLE in children usually was moderate-severe grade.2. The disease character is mainly manifested as excess syndrome and syndromes mingled with deficiency and excess. The main pattern of syndrome on admission usually is deficiency of both qi and Yin, asthenia of both the spleen and kidney, muscle in feng shui, Yin deficiency with internal heat, toxic heat flourishing;deficiency syndrome slightly increased after admission. The top four colors of tongue are red, pink, dark red, light dark; the top four coating are yellow thick greasy fur, yellow fur, white thick greasy fur, white fur; the top four pulse condition are thready pulse, rapid pulse, slip pulse, and string pulse.3.97.78%children treated by combination of traditional Chinese and western medicine, most got better and discharged from hospital, the total effective rate of treatment was 91.11%. Glucocorticoid is the basic medicine for the SLE in children, some children combined with immune inhibitors, antimalarial drugs, static drops of immunoglobulin. At the same time, combining with adjuvant therapy of decoction of Chinese medicine and Chinese patent drug; Methods mainly are nourishing qi and Yin, tonifying spleen and kidney, clearing heat and expelling damp, and promoting blood circulation to remove stasis; main medicines including heat-clearing drugs, tonic drugs, damp-expelling drugs and blood-activating drugs.4. The main factors of repeated hospital admission incluing infection, solarization, medicine, cold and fatigue. The dose of hormone used in children of repeated hospital admission were significantly redused than the first hospitalization, while the other drugs’dose generally keep thesame.Conclusion1. The onset forms and clinical syndromes of SLE in children are complicated and various, mainly involving the kidney, with heavy common. The SLEDAI score is not only a quantitative assessment of the children with SLE, but also an important reference for clinical medicine.2. Chinese medicine treatment in children with SLE should tonic mainly, and then clear heat. The main kinds of medicine including heat-clearing drugs,tonic drugs, damp-expelling drugs and blood activating drugs.3. The therapy of our hospital in combining traditional Chinese and western medicine of SLE in children have certain characteristics, mainly with hormone+immunosuppressor+Chinese patent medicine+decoction of Chinese medicine, and hormone+immunosuppressor+immunoglobulin+Chinese patent medicine+decoction of Chinese medicine.4. Some children have to require a hospital readmission, in addition to the need of disease activity, also for children with a regular admission and condition assessment to adjust the treatment plan. |
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