Clinical Retrospective Analysis Of Henoch-schonlein Purpura Nephritis In 136 Children

Objective: To explore the general conditions,clinical features,laboratory tests,syndrome differentiation and clinical classification of traditional Chinese medicine,the rules of differentiation and treatment of traditional Chinese medicine,and therapeutic effects in children with Henoch-schonlein purpura nephritis in our hospital to improve the understanding of this disease and provide reference for clinical diagnosis and treatment.Methods: The general conditions of cases of children with Henoch-schonlein purpura nephritis admitted to the pediatric department of the First Affiliated Hospital of Yunnan College of Traditional Chinese Medicine from December 2013 to December 2016 and met the inclusion criteria(gender,age,disease course,season of onset,and cause of morbidity),clinical features,laboratory tests(general examinations,renal examinations,etc.),TCM related factors(TCM syndrome differentiation,Chinese medicine differentiation and treatment laws),etc.were used for retrospective analysis of statistical methods,using Excel and SPSS 21.0 software for statistical analysis.Result:1.General situation: In this study,a total of 136 cases of children with HSPN were collected.The average age of onset was(8.91±2.86)years,and the high-risk age range was 7 to 12 years old,a total of 80 cases(58.8%).The gender ratio is 1.43:1.The disease is high in the winter and spring,accounting for 58.82% of the year.2.Pathogenesis incentives: Respiratory tract infections were the main cause of HSPN in children,accounting for 47.1% of the total;children with food allergies accounted for 17.1%;children with drug allergy accounted for 4.4%;children with other factors accounted for 4.4%;other children did not have a clear cause of the disease.3.Clinical features: 136 cases of childhood HSPN children with skin purpura and kidney symptoms accounted for 16.17%,joint and renal symptoms accounted for11.02%,gastrointestinal and renal symptoms accounted for 13.97%,skin purpura,joint symptoms and kidney symptoms accounted for 15.44%,articular,gastrointestinal,and renal symptoms accounted for 13.23%;skin purpura,gastrointestinal symptoms and kidney symptoms accounted for 18.38%;skin purpura,joint symptoms,gastrointestinal symptoms and kidney symptoms accounted for11.76%.Clinical classification showed hematuria and proteinuria in 68 cases(50.00%),isolated proteinuria in 37 cases(27.21%),isolated hematuria in 22 cases(16.17%),nephrotic syndrome in 9 cases(6.61%).Urine routinely showed urine occult blood and urinary protein qualitative negative in 11 cases(8.08%),abnormal urine occult blood in 124 cases(91.17%),protein qualitative abnormalities in 70 cases(51.47%),urine occult blood and urine protein abnormalities in 70 cases(51.47 %).4.Laboratory tests: Blood routine: WBC count increased in 50 cases,decreased in 26 cases,NEUT increased in 65 cases,decreased in 36 cases.The percentage of LYMPH increased in 44 cases and decreased in 25 cases.RBC counts increased in 21 cases,decreased in 16 cases,elevated HB in 32 cases,decreased in 15 cases,and increased PLT count in 38 cases.Urine routine: urinary protein(+)in 70 cases,Urine occult blood(+)in 124 cases,red blood cell(+)in 88 cases,leukocyte in(+)in 43 cases.Fecal routine: Microscopic examination of white blood cells(+)in 25 cases,microscopy of red blood cells(+)in 30 cases,faecal occult blood in(+)in 65 cases.Kidney-related examination: 24 h urinary protein measurement(+)122 cases,urine microalbumin determination(+)80 cases.Uric acid increased in 39 cases.Renal B-ultrasonography was abnormal in 11 cases.5.TCM Syndrome Differentiation and Clinical Classification: TCM Syndrome Classification: 60 Cases of Wind-Heat Trauma Collateral;18 cases of Blood Heat-Injury Syndrome;15 Cases of Damp-Heat-Injury Syndrome;13 Cases of Gastrointestinal Heat Syndrome;Cases;qi deficiency and blood stasis syndrome in 9cases;yin deficiency and fire syndrome in 7 cases.The relationship between dialectical classification of TCM and clinical classification,wind-heat injury syndrome is more common in solitary hematuria and hematuria and proteinuria,hot and humid wound syndrome syndrome,and blood heat injury syndrome are more common in hematuria and proteinuria,spleen and kidney yang deficiency Isolated proteinuria is more common,and other TCM syndromes and clinical types have occurred.6.The rule of differentiation and treatment of traditional Chinese medicine: The total frequency of hematuria and proteinuria in Chinese medicine treatment was47.07%.The top ten commonly used traditional Chinese medicines are: wind,Nepeta,valerian,licorice,agrimony,comfrey,peony,atractylodes,red peony,motherwort.30 clusters of high-frequency drug system cluster analysis:(1): wind,Nepeta;(2): grass,licorice,Agrimony,Lithospermum;(3): small peony,Atractylodes,red peony,Motherwort;(4): Lycopersicon esculenta,Astragalus,Sophora flavescens,Rhizoma Imperatae,Cortex Moutan,Gorgon Fruit,Honeysuckle,Mung Bean,Chixiaodou,Forsythia,Fried Black Bean,Coix Seed,Ink Eclipta,Smilax,Talc,Jiijin,Pork,Chinese Yam,Buffalo horn,Rehmannia.Clinical use of drugs to dilute the wind cold medicine,heat and cooling medicine,qi drugs,phlegm hemostatic drugs,cooling blood hemostatic drugs are the most commonly used.The drug category treats "sputum","heat","wind","wet",and "deficiency".7.Therapeutic effect: The children were treated with TCM comprehensive treatment and combination of traditional Chinese and Western medicine.After treatment,the total effective rate was 96.32%.Conclusion:1.Children with Henoch-schonlein purpura nephritis occur in 7 to 12 years old,male children more than female children,high incidence of winter and spring.2.Respiratory tract infection is the main cause of Henoch-schonlein purpura nephritis in children.3.The clinical manifestations of the clinical symptoms were the most common in the skin purpura,joint symptoms,gastrointestinal symptoms,and renal symptoms.The proportion of simple renal symptoms was the least.The distribution of clinical classification was the highest in hematuria and proteinuria,and nephrotic syndrome was the least.The degree of proteinuria in children with aggravated hematuria and aggravated,and hematuria positive children than proteinuria positive children.4.The related laboratory tests can comprehensively reflect the degree of Henoch-schonlein purpura nephritis in children.5.TCM syndrome differentiation syndrome is the most common with wind-heat-injury syndrome,deficiency syndrome spleen-kidney yang deficiency syndrome,qi deficiency and blood stasis syndrome,and yin deficiency syndrome are rare.The relationship between dialectical classification of TCM and clinical classification is wind-heat injury syndrome.Isolated hematuria and hematuria and proteinuria are more common.Hemothermal injury syndrome and blood heat injury syndrome are more common in hematuria and proteinuria,spleen and kidney yang deficiency.Isolated proteinuria is more common.6.Chinese medicine treatment of hematuria and proteinuria accounted for more drugs.Classification of traditional Chinese medicine drugs to divergent wind cold medicine,cooling heat medicine,qi drugs,phlegm hemostatic drugs,cooling blood hemostatic drugs are most commonly used.The categories of drugs are mainly composed of drugs for treating "sputum",treating "hot",and treating "wind",and supplemented by treating "wet" and "viral" drugs.7.In our hospital,the effect of comprehensive treatment of traditional Chinese medicine and combination of traditional Chinese and Western medicine is obvious,but some children with severe cases still need further study to improve the efficacy.