| Objective:To evaluate the clinical efficacy of clearing heat and dampness,activating blood and detoxification Chinese medicine on children Henoch-Schonlein purpura(HSP)of dampness-toxic syndrome,to explore the factors affecting the efficacy and recurrence of children with HSP of dampness-toxic syndrome and to investigate correlation between serum vitamin D level and the clinical manifestations,inflammatory response,blood coagulation and immune function of HSP.Methods:1 Using prospective randomized controlled study method,children with HSP of dampness-toxic syndrome were selected as the research objects,who were randomly divided into Chinese medicine treatment(TCM)group and western medicine control group.The TCM group was given oral Chinese medicine to clear heat and dampness,promote blood circulation and detoxify on the basis of conventional western medicine treatment,while the western medicine control group was only given conventional western medicine treatment,with a total course of 2 weeks in both groups.Efficacy rate,C-reactive protein,blood coagulation index and urine test were compared between the two groups.Outpatient or telephone follow-up was conducted on the 2nd,3rd,4th and 6th months after the clinical recovery.The recurrence situation of the children were recorded and the recurrence rate was compared between the two groups.2 Patients with HSP of dampness-toxic syndrome were selected who were treated on the basis of the treatment plan,in accordance with the treatment,curative effect was evaluated after the complete course.According to the curative effect,the children were divided into the cured group and the uncured group,and the related factors that might affect the clinical efficacy of the children were analyzed.According to the recurrent situation,the children were divided into recurrent group and non-recurrent group,and the risk factors related to the recurrence of HSP were analyzed.3 Analyze the correlation between vitamin D level and clinical performance score,C-reactive protein,blood coagulation indexes and immune indexes before and after treatment in children with HSP.Result:1 A total of 102 HSP patients of dampness-toxic syndrome were included,with a male to female ratio of 1.32:1.The incidence rate in boys was higher than that in girls.The median age of onset was 8(6,11)years old,25(24.5%)children in pre-school age,77(75.5%)children in school age and adolescence,and the median medical history was 10(6,19.5)days.2 After treatment,the total effective rate of the two groups was 88.2%in the TCM group and 60.8%in the control group.The total effective rate of the TCM group was significantly higher than that of the control group(P=0.012).In terms of clinical performance,the total score of TCM group after treatment were significantly lower than that of the control group(P<0.01).The scores of skin symptoms,joint symptoms,digestive tract symptoms and abdominal B-ultrasound were compared respectively.Compared between the two groups,the scores of skin symptoms and digestive tract symptoms in the TCM group were significantly lower than those in the control group(P<0.05).After treatment,there was no significant difference in C-reactive protein,platelet count and fibrinogen between the two groups.The level of D-dimer in the TCM group was significantly lower than that in control group after treatment(P=0.009).There was no significant difference between the two groups in urine abnormality.In terms of recurrence,there were 4 cases of recurrence in the TCM group and 12 cases in the control group,and the difference of recurrence rate between the two groups was statistically significant(P<0.05),the recurrence rate in the TCM group was lower than that in the control group.The causes of recurrence included respiratory tract infection in 4 cases(25.0%),fatigue in 1 case(6.3%),diet in 2 cases(12.5%),and unclear in 9 cases(56.3%).3 Univariate analysis of curative effect factors showed that children with HSP aged more than 7 years had a higher clinical recovery rate.Both univariate and multivariate analyses showed that platelet elevation(>300×109/L)was a risk factor affecting the therapeutic effect of HSP.4 In univariate and multivariate analysis,elevated D-dimer(>0.243mg/L)and vitamin D deficiency(≤20ng/ml)after treatment were the risk factors for the recurrence of HSP.5 25(OH)D level in children with HSP before treatment only had weak negative correlation with clinical performance score(r=-0.235,P=0.018),and had no significant correlation with C-reactive protein,blood coagulation index and immune index.After treatment,25(OH)D level had moderate negative correlation with serum IgA level(r=-0.682,P<0.001),serum IgG level(r=-0.307,P=0.002),and weak correlation with CD4+T cell percentage(r=0.211,P=0.033).There was a weak negative correlation between 25(OH)D level and IgA level(r =-0.223,P=0.024),and between 25(OH)D level and CD4+T cell percentage(r=0.195,P=0.049).The difference of 25(OH)D level before and after treatment was weakly negatively correlated with the difference of IgA(r=-0.223,P=0.024),and with the difference of CD4+T cell percentage(r=0.195,P=0.049).Conclusion:For children with HSP of dampness toxic syndrome,the application of clearing heat and dampness,activating blood and detoxification Chinese medicine combined with western medicine has a significant clinical effect and excellent security,especially in the improvement of skin symptoms and digestive tract symptoms,it has a good effect on the reduction of D-dimer,and the main risk factors affecting the effect are platelet elevation.In terms of recurrence,Chinese medicine can effectively reduce the recurrence rate and improve the long-term prognosis.Risk factors affecting recurrence mainly include increased D-dimer and deficiency of vitamin D level after treatment.Vitamin D may affect recurrence by regulating cellular and humoral immune functions in children.Therefore,more attention should be paid to dynamic monitoring of the changes of the level of D-dimer and serum 25(OH)D,follow-up of children with abnormal indicators should be strengthened. |
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