Abstract:

To observe the dynamic changes of serum TNF-α，IL-18 and IL-10 in children with primary nephrotic syndrome（PNS） and

the effect of Huaiqihuang particles on these inflammatory factors ，infection and relapse of the patients. Methods　Totally 67 patients first

diagnosed with PNS were randomly divided into group A （35 cases） and group B （32 cases）. Group A was treated with prednisone and

Huaiqihuang particles，while group B was treated with prednisone only. Observe the serum TNF-α，IL-18 and IL-10 level before the treatment，

0.5 month，1 month，3 months and 6 months after treatment. Record the infection and relapse patients within 1 year. Group C was control group

（25 healthy children）. Serum TNF-α，IL-18 and IL-10 level was detected by ELISA. Results　（1）The infection times of group A（0.54 time

each patient）were significantly fewer than group B（1.81 time each patient）， and the relapse cases of group A（7，37.5%） were fewer than

group B（12，37.5%）.（2）TNF-α： Before treatment， the serum level was higher than group C（P < 0.05）； 0.5 month after treatment， it

decreased to normal in both group A and B（P < 0.05）， then maintained at normal level；there were no differences between the two groups. （

3）IL-18：Before treatment， the serum level of groups A and B was higher than group C（P < 0.05）； it decreased significantly after 3

months’treatment （P < 0.05）in group A， which was lower than that of group B but still higher than that of group C（P < 0.05）. （4）IL-10

：Before treatment， the serum level of the gwo groups was higher than group C（P < 0.05）； 0.5 month after treatment， it decreased in both

group A and B（P < 0.05）； there were no differences between the two groups. Six months after treatment， it increased significantly in

group A ， higher than group B（P < 0.05）， but still did not reach the normal level. （5）Relapse cases： Serum TNF-αlevel in group A was

lower than that of group B（P < 0.05）. There were no differences between the two groups in IL-18 and IL-10 level. Conclusion　TNF-α，IL-18

and IL-10 participate in the pathogenesis of PNS. The imbalance of inflammatory factors and inhibited factors may be one of the pathogenesis

of PNS. Huaiqihuang particles can prevent the infection and relapse of PNS children，by reducing the inflammatory effects of IL-18 and

enhancing the inhibitory effects of IL-10.

Key words: primary nephrotic syndrome（PNS）； TNF-α； IL-18； IL-10； Huaiqihuang particles

摘要：

观察原发性肾病综合征（PNS）患儿血清肿瘤坏死因子（TNF-α）、白细胞介素（IL）-18、IL-10的动态变化，及槐杞黄颗粒对炎症因子和感染、复发的影响。方法　2008 - 06 - 01—2009 - 07 - 31收治于中国医科大学附属盛京医院小儿肾内科的初发PNS患儿67例，随机分为两组：槐杞黄组35例，给予泼尼松加槐杞黄颗粒口服；激素组32例，单纯给予泼尼松口服。观察两组治疗前，治疗0.5、1、3和6个月血清 TNF-α、IL-18、IL-10的动态变化，并记录1年内感染和复发次数。健康体检儿童25名为对照组。采用ELISA方法检测血清TNF-α、IL-18、IL-10。结果　（1）槐杞黄组感染次数（19例次）明显少于激素组（58例次），槐杞黄组复发例数（7例，20%）明显少于激素组 （12例，37.5%）。（2）治疗前两组未复发病例TNF-α显著高于对照组，差异有统计学意义（P < 0.05）；0.5个月时两组均显著下降至正常水平（P < 0.05），之后无明显变化，组间无差异。（3）治疗前两组未复发病例IL-18明显高于对照组，差异有统计学意义（P< 0.05）；至3个月后槐杞黄组显著降低（P < 0.05），并低于激素组，但仍明显高于对照组（P < 0.05）。（4）治疗前两组未复发病例IL-10显著低于对照组，差异有统计学意义（P < 0.05）；0.5个月时槐杞黄组、激素组均明显降低，分别为（6.75±1.77） pg/mL、（7.79±3.01） pg/mL，且低于治疗前（P < 0.05），两组间差异无统计学意义；至6个月时槐杞黄组明显上升[（13.29±7.19） pg/mL]且高于激素组[（7.48±3.04） pg/mL]（P < 0.05）及治疗前，仍未达到正常水平。（5）复发病例中，槐杞黄组TNF-α显著低于激素组（P < 0.05），两组IL-10及IL-18差异无统计学意义。结论　TNF-α、IL-18、IL-10参与PNS的发病，致炎因子/抑炎因子失衡可能是PNS的发病机制之一。槐杞黄颗粒可能通过降低IL-18的致炎作用，增强IL-10的抑炎作用，从而减少PNS 患儿感染及复发。

关键词: 原发性肾病综合征, 肿瘤坏死因子&alpha, 白细胞介素18, 白细胞介素10, 槐杞黄颗粒