| Objective:To observe the clinical efficacy of Liangxue Tiaomian Decoction combined with conventional Western medicine therapy for the treatment of pediatric HenochSchonlein purpura(HSP),to evaluate the effect of Liangxue Tiaomian Decoction on Th17/Treg imbalance in children with HSP,and to propose the therapeutic mechanism of Liangxue Tiaomian Decoction in the treatment of pediatric HSP.Method:Sixty children with initial urine protein-negative HSP were randomly assigned,using random number table,to the test group or control group;58 patients eventually completed the study,including 29 in the test group and 29 in the control group.The test group received Liangxue Tiaomian Decoction +conventional Western medicine therapy,while the control group received conventional Western medicine therapy alone.Patients were observed and followed up for 6 months,and the time to resolution of rash,arthralgia and abdominal pain,HSP recurrence,and renal injury were recorded for both groups.Flow cytometry and ELISA were used to detect Treg and IL-17 pre-and posttreatment in both groups;Treg and IL-17 were also detected for 30 healthy children over the same period to provide healthy controls.Result:(1)Comparison of response rate(cure rate + markedly effective rate): The response rate was 96.55% in test group and 72.41% in the control group,with statistically significant difference(P=0.03);(2)Comparison of mean time to resolution of rash,arthralgia,and abdominal pain: The mean time to resolution of rash,arthralgia,and abdominal pain was 4.44±2.33(days),2.57±1.13(days),and 1.33±0.58(days),respectively,in the test group,and was 6.47±3.25(days),3.14±1.57(days),and 2.00±0(days),respectively,in the control group;the mean time to resolution of rash was significantly reduced in the test group,with statistically significant difference(P=0.008);there were no statistically significant differences between the two groups in the mean time to resolution of arthralgia or abdominal pain(P=0.118 and P=0.073,respectively);(3)Comparison of recurrence rate: The recurrence rate was 10.34% in the test group and 41.38% in the control group,which was significantly lower in the test group,with statistically significant difference(P=0.007);(4)The proportion of patients developing hematuria and/or proteinuria posttreatment was 3.45% in the test group and 10.34% in the control group,without statistically significant difference(P=0.604);(5)Changes in Treg and IL-17 pre-and post-treatment and comparison with healthy control group: Comparison with healthy control group: Treg(%)in the healthy control group,in the test group pre-treatment,in the control group pre-treatment,in the test group post-treatment,and in the control group post-treatment was 8.14±2.71,6.63±1.52,6.78±2.21,7.96±1.98,and 7.67±2.09,respectively;IL-17(pg/m L)was 13.81±2.98,23.55±5.64,23.39±5.56,14.22±3.85,and 16.18±4.09,respectively.Before treatment,Treg was lower in both the test and control groups than in the healthy control group,with statistically significant differences(P=0.011 and P=0.039,respectively),and had no statistically significant difference between the test and control groups(P=0.764);after treatment,Treg increased in both the test and control groups,with statistically significant increase in the test group(P=0.005)and no statistically significant increase in the control group(P=0.125),remained lower in the test group than in the healthy control group without statistically significant difference(P=0.772),and was higher in the test group than in the control group without statistically significant difference(P=0.59).Before treatment,IL-17 was higher in both the test and control groups than in the healthy control group,with statistically significant differences(both P<0.001),and had no statistically significant difference between the test and control groups(P=0.912);after treatment,IL-17 decreased significant in both the test and control groups(both P<0.001),but remained higher than in the healthy control group,with statistically significant difference between the control and healthy control groups(P=0.007);post-treatment IL-17 decreased more significantly and was lower in the test group than in the control group,with statistically significant difference(P=0.049),and had no statistically significant difference between the test and healthy control groups(P=0.733).Conclusion:In the treatment of pediatric HSP,compared with conventional Western medicine therapy alone,Liangxue Tiaomian Decoction combined with conventional Western medicine therapy could provide higher response rate,significantly reduce recurrence,and shorten the time to rash resolution,yet could not significantly reduce renal injury or relieve arthralgia and abdominal pain.Liangxue Tiaomian Decoction could exert a regulatory effect on elevated IL-17 and decreased Treg%,i.e.,Th17/Treg functional imbalance,in acute phase of pediatric HSP. |
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