Effect of blood hyper coagulability of Henoch-Schonlein purpura nephritis in children treated by traditional herb with activating blood and removing blood Stasis combined with terygium wilfordii Guan Zhiwei, Zhai Wensheng, Ren Xianqing, Guo Qingyin, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou, Henan, 450000, China Author’s Bio: Guan Zhiwei (1980-), Male, Physician, M.S. Research interests: Prevention and treatment of pediatric renal diseases by Chinese medicine. E-mail:[email protected] Correspondence should be addressed to DING ZHAO, F, Chief Physician, Ph. Research interests: Prevention and treatment of pediatric renal diseases by Chinese medicine. E-mail:[email protected] 【Abstract】Objective To observe the effect of blood activation and blood stasis removal method combined with Leigongtang polyglucoside on the coagulation status of pediatric purpura nephritis (HSPN). Methods Forty-eight children with HSPN were treated with the method of activating blood circulation and removing blood stasis combined with rehmannia polyglucoside, and the coagulation indexes were tested before and at the end of 12 weeks of treatment. Results When comparing before and after treatment, the improvement of partial thromboplastin time (APTT), fibrinogen (FiB) and D-dimer (D-dimer) were statistically significant (P < 0.01); prothrombin time (PT) and thromboplastin time (TT) improved after treatment compared with before treatment, but the difference was not statistically significant (P > 0.05). Conclusion The combination of blood-activating and blood-stasis-removing method and rehmannia polysaccharide had a significant improvement on the hypercoagulable state of pediatric purpura nephritis. 【Key words】 Blood-activating and stasis-clearing method; Leigongtang polyglucoside; children; purpura nephritis; coagulation status Pediatric allergic purpura (HSP) with renal injury is called purpura nephritis, most children have a good prognosis, but some children can progress to renal failure, and coagulation disorders are the cause of the development of renal parenchymal lesions [1]. Early intervention treatment of coagulation status in children with HSPN is of great importance to alleviate clinical symptoms, reduce renal impairment and prevent the occurrence of renal failure. In this study, by observing the changes of coagulation indexes in children before and after treatment, we found that the treatment of children with purpura nephritis with blood activation and blood stasis method combined with rehmannia multi-glucoside improved their hypercoagulable state significantly, which is reported as follows: 1 Data and methods 1.1 Clinical data 48 cases were children with HSPN hospitalized in 2008-09/2009-05 in the First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Department of Pediatrics. Among them, 30 cases were male and 18 cases were female; the average age was 9.81±3.38 years; the duration of purpura was 43.65±21.74 days; the duration of kidney injury was 24.79±19.18 days. 1.2 Diagnostic criteria The diagnosis of HSP was in accordance with the diagnostic criteria of Zhu Fu Tang Practical Pediatrics [2].The diagnosis of HSPN was made with reference to the diagnostic criteria formulated by the Nephrology Group of the Chinese Pediatrics Branch at its meeting in Zhuhai in 2000 [3]: ① hematuria and/or proteinuria appearing during the course of HSP or within 6 months after the purpura subsided; ② the diagnosis of renal pathology was in accordance with HSPN; ③ clinical exclusion of lupus erythematosus, Vasculitis and other diseases caused by kidney damage. With 1, 3 can be diagnosed HSPN. 1.3 Inclusion criteria ① in line with the above diagnostic criteria, the typology of hematuria and proteinuria type, 24-hour urine protein quantification of ≥ 400mg or ≥ 25mg/kg, and < 50mg/kg and 3.5g; ② with renal pathology results of its pathological classification should be Ⅰ to Ⅲ, the proportion of crescentic ≤ 25%; ③ age ≥ 2 and ≤ 16 years old ④ duration of disease ≤ 3 months; ⑤ urine test abnormalities for more than 1 week (urine routine examination more than 2 times); ⑥ for urine test abnormalities recently (the last 10 days) have not used hormones, CTX, tretinoin polysaccharide tablets, enzyme phenolate and other immunosuppressive agents. 1.4 Exclusion criteria ①Do not meet the above diagnostic criteria, and the clinical type is other than hematuria-cum-proteinuria type typology; ②People with renal pathology grading ≥ grade IV and crescentic proportion > 25%. (③) Those with renal damage caused by systemic lupus erythematosus, vasculitis, viral hepatitis (hepatitis C, hepatitis B, etc.), hypercalcemia, and hematuria and proteinuria caused by hypercalcemia and left renal vein compression syndrome, etc. ④Persons with persistent hypertension or renal insufficiency (persistent azotemia). ⑤ Those who are <2 years old or >16 years old; those who are allergic to this drug. 1.5 Treatment method Activating blood circulation and resolving blood stasis: clearing heat and stopping bleeding granules + Danshen injection, clearing heat and stopping bleeding granules using Jiangyin Traditional Chinese Medicine Factory Tianjiang brand formula granules, basic composition: Shengdi, Danpi, Red Peony, Dry Lotus Grass, Panax notoginseng, Little Thistle, Cyperus, Danshen, Licorice. The treatment course is 12 weeks. Danshen Injection: produced by Shenwei Pharmaceutical, usage: 0.5 ml/kg・d, 2 weeks course of treatment. Radix polygoni (produced by Jiangsu Meitong Pharmaceutical, batch number: 000303), usage: 1.5 mg/kg・d (maximum dose not exceeding 90 mg/d) orally for 1-4 weeks, followed by 1 mg/kg・d for 8 weeks from 5 to 12 weeks. 1.6 Observation indexes were measured according to the operating procedures of our thromboembolic chamber and the corresponding kits. Before treatment and at the end of 12 weeks of treatment, venous blood was taken once in the morning on an empty stomach for each of the five coagulation tests. 1.7 Statistical methods: SPSS13.0 software was used for statistical analysis. The measurement data were expressed by ( ), and intra-group comparison was performed by paired t-test, and P < 0.01 was considered a statistically significant difference. 2 Results Table 1 Comparison of coagulation status of children before and after treatment ( ) Coagulation indexes Before treatment After treatment PT(s) 11.62±0.97 11.74±1.04 TT(s) 14.39±2.52 15.06±2.12 APTT(s) 30.37±4.29 32.79±5.37▲ FIB(g/L) 3.36±0.99 2.42± 0.44▲ D-dimer (mg/L) 0.20±0.12 0.14±0.05▲ Note: ▲t=-3.132, 6.425, 3.68; ▲P=0.003, 0.000, 0.001. The results in Table 1 illustrate that APTT, FIB, and D-dimer were statistically significant before and after treatment (P<0.01), suggesting that after treatment The hypercoagulable state of blood was significantly improved compared with before; PT and TT were improved compared with before after treatment, but not statistically significant. According to its clinical manifestations and pathogenetic characteristics, the purpura stage can be classified as "epistaxis" and "grape disease" in Chinese medicine; when accompanied by kidney damage, it is similar to the "blood evidence" and "blood disease" in Chinese medicine. When accompanied by kidney damage, it is related to "blood evidence", "blood in urine", "edema", etc. in Chinese medicine. Numerous studies have concluded [4] that this disease is mostly related to the invasion of wind, heat, or poisonous evil, which turns into fire and burns the blood channels; or deficiency in the body or depletion of qi in prolonged illness, where qi does not take in blood, the kidney loses its fixation and sealing, and blood loses its attachment and overflows outside the veins; or yin deficiency and fire, where deficiency fire injures the blood channels and appears as blood evidence. The blood that leaves the meridian stays and becomes stasis, and if the disease enters the luo for a long time, or if the stasis blocks the luo and the blood does not return to the meridian, the bleeding is repeated or aggravated. Therefore, stasis of blood and stagnation [5] are the main pathological aspects of the disease mechanism, which are mutually causative with "overflow" and continue throughout the course of the disease. Therefore, the treatment of this disease can achieve good clinical results by clearing heat and cooling blood, activating blood circulation and stopping blood stasis [5], so activating blood circulation and removing blood stasis is the key to the treatment of this disease. HSPN is a manifestation of immune response-induced systemic capillaritis in the kidney [6], and the lesion process has the participation of coagulation mechanism, and the hypercoagulable state is particularly prominent [7]. Studies have proved [8] that blood-activating drugs have the ability to increase fibrinolytic enzyme activity, promote fibrinolysis, inhibit platelet aggregation, reduce capillary permeability and improve microcirculation, promote renal lesion repair and fibrin absorption, reduce edema or proteinuria, and adjust immune function. It inhibits or reduces metabolic damage, inhibits connective tissue metabolism, prevents renal fibrous tissue proliferation, and promotes the transformation and absorption of proliferative lesions. Therefore, the method of activating blood circulation and removing blood stasis is used throughout the treatment process, which plays an important role in improving the therapeutic effect of this disease and improving the hypercoagulable state. Based on long-term clinical experience, the formula is developed for the etiology and pathogenesis of purpura nephritis. In this formula, Radix Rehmanniae is used as the ruler to cool the blood and stop bleeding; Dangpi and Radix Paeoniae are used as the subjects to cool the blood and activate blood circulation and disperse blood stasis; Dried Lotus Grass, Panax notoginseng, Xiaoxia, Radix et Rhizoma and Salviae Miltiorrhizae are used as the adjuvants to cool the blood and stop bleeding, resolve blood stasis and nourish Yin and clear heat; Licorice is used to harmonize all the medicines as the ambassadors; the whole formula works to cool the blood, resolve blood stasis and stop bleeding and nourish Yin. At the same time, salvia can dilate blood vessels, increase renal blood flow, inhibit immune complex reaction and thromboxane formation, antagonize microvascular spasm and platelet aggregation, and reduce blood viscosity [9-10], thus blocking the development of renal pathology. It is a mixture of polar fat-soluble components extracted from the root of Radix Rehmanniae, a plant of the family Weigelaeaceae, which retains the herbal functions of Radix Rehmanniae in activating blood stasis, clearing heat and cooling blood, detoxifying and decongesting, but also removes many toxic components, and is a non-steroidal immunosuppressive agent with strong anti-inflammatory and immunosuppressive effects, which is widely used in the treatment of pediatric allergic purpura nephritis. treatment. Radix polyglycoside has some degree of anticoagulation, correction of fibrinolytic disorders, reduction of blood viscosity, improvement of blood rheological properties, and improvement of microcirculation [11]. Long-term clinical practice has verified [12] that the combination of blood activation and blood stasis treatment with leigongtang polyglucoside in the treatment of pediatric purpura nephritis can significantly improve the remission rate of purpura nephritis, reduce the recurrence rate, and significantly improve the hypercoagulable state of blood. This study showed that the combination of blood activation and blood stasis treatment method with leigongtang polyglucoside could significantly improve the blood hypercoagulability in children with purpura nephritis. Some factors of hypercoagulation mechanism are the result of nephropathological changes, and the combination of blood activation and blood stasis method with leigong doside can significantly improve the blood hypercoagulation status in children with HSPN, which may also inhibit the nephropathological changes, and deserves further study. References [1] Wang Z.Y., Li J.Z., Ruan C.G., et al. 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