西咪替丁联合孟鲁司特钠对紫癜性肾炎患儿血清炎性因子、肾功能指标、凝血功能指标及Th1/Th2比值的影响
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摘要
目的研究西咪替丁联合孟鲁司特钠对紫癜性肾炎患儿血清炎性因子、肾功能指标、凝血功能指标及Th1/Th2比值的影响。方法选取2014年1月至2017年12月于本院就诊的160例紫癜性肾炎患儿为研究对象,按照随机数表法将其分为观察组和对照组,每组各80例,两组患儿均给予盐酸西替利嗪、葡萄糖酸钙、维生素C治疗,在此基础上,对照组患儿加用西咪替丁治疗,观察组患儿加用西咪替丁和孟鲁司特钠治疗。两组患儿疗程均为3个月,比较治疗前后两组患儿血清炎性因子、肾功能指标、凝血功能指标及Th1/Th2比值。结果治疗后,两组患儿白细胞介素(interleukin,IL)-4、IL-6、IL-8、IL-17、IL-18、Th2、肿瘤坏死因子-α、转化生长因子-β_1、C反应蛋白、24 h尿蛋白定量、血肌酐、血尿素氮、微量白蛋白、β_2微球蛋白、免疫球蛋白G、α_1-微球蛋白、N-乙酰-β-葡萄糖苷酶、血小板、血浆纤维蛋白原、D-二聚体、纤维蛋白降解产物水平均显著低于本组治疗前(P_均<0.05),IL-10、IL-12、Th1水平及Th1/Th2比值均显著高于本组治疗前(P_均<0.05),活化部分凝血活酶时间、凝血酶时间、凝血酶原时间均显著长于本组治疗前(P_均<0.05),且观察组患儿上述指标水平变化幅度均显著大于对照组(P_均<0.05)。治疗期间两组患儿各不良反应发生率比较均无显著差异(P_均> 0.05)。结论西咪替丁联合孟鲁司特钠治疗紫癜性肾炎,可有效改善患儿血清炎性因子水平及其肾功能和凝血功能,调节Th1/Th2免疫失衡,安全性较好。
Objective To study the effects of Cimetidine combined with Montelukast sodium on serum inflammatory factors, renal function indexes, coagulation function indexes and Th1/Th2 ratio in children with Henoch-Schonlein purpura nephritis. MethodFrom January 2014 to December 2017, 160 children with Henoch-Schonlein purpura nephritis were randomly divided into observation group and control group, 80 cases in each group, both groups children were treated with Cetirizine hydrochloride, Calcium gluconate and Vitamin C. On this basis, children in control group were treated with Cimetidine, and children in observation group were treated with Cimetidine and M ontelukast sodium. The course of treatment was 3 months in both groups, serum inflammatory factors, renal function indexes, coagulation function indexes and Th1/Th2 ratio were compared between the two groups before and after treatment. Result After treatment, interleukin(IL)-4, IL-6, IL-8, IL-17, IL-18, Th2, tumor necrosis factor-α(TNF-α), transforming growth factor-β_1, C-reactive protein, 24-hour urinary protein, serum creatinine, blood urea nitrogen, microalbumin, β_2-microglobular, immunoglobulin G, α_1-microglobulin, N-acetyl-β-glucosidase, platelet, plasma fibrinogen, D-dimer and fibrin degradation products were significantly lower than those before treatment(P_(all)< 0.05), the levels of IL-10, IL-12, Th1 and Th1/Th2 ratio were significantly higher than those before treatment(P_(all)< 0.05), activated partial thromboplastin time, thrombin time and prothrombin time were sighificantly longer than those before treatment(P_(all)< 0.05), and the changes of the above indexes in observation group were significantly higher than those in control group(P_(all)< 0.05). There were no significant differences in the rate of adverse reactions between the two groups during the treatment(P_(all)> 0.05). Conclusion Cimetidine combined with Montelukast sodium in the treatment of Henoch-Schonlein purpura nephritis can effectively improve the level of serum inflammatory factors, renal function and coagulation function, regulate the immune imbalance of Th1/Th2, and the safety is good.
Objective To study the effects of Cimetidine combined with Montelukast sodium on serum inflammatory factors, renal function indexes, coagulation function indexes and Th1/Th2 ratio in children with Henoch-Schonlein purpura nephritis. MethodFrom January 2014 to December 2017, 160 children with Henoch-Schonlein purpura nephritis were randomly divided into observation group and control group, 80 cases in each group, both groups children were treated with Cetirizine hydrochloride, Calcium gluconate and Vitamin C. On this basis, children in control group were treated with Cimetidine, and children in observation group were treated with Cimetidine and M ontelukast sodium. The course of treatment was 3 months in both groups, serum inflammatory factors, renal function indexes, coagulation function indexes and Th1/Th2 ratio were compared between the two groups before and after treatment. Result After treatment, interleukin(IL)-4, IL-6, IL-8, IL-17, IL-18, Th2, tumor necrosis factor-α(TNF-α), transforming growth factor-β_1, C-reactive protein, 24-hour urinary protein, serum creatinine, blood urea nitrogen, microalbumin, β_2-microglobular, immunoglobulin G, α_1-microglobulin, N-acetyl-β-glucosidase, platelet, plasma fibrinogen, D-dimer and fibrin degradation products were significantly lower than those before treatment(P_(all)< 0.05), the levels of IL-10, IL-12, Th1 and Th1/Th2 ratio were significantly higher than those before treatment(P_(all)< 0.05), activated partial thromboplastin time, thrombin time and prothrombin time were sighificantly longer than those before treatment(P_(all)< 0.05), and the changes of the above indexes in observation group were significantly higher than those in control group(P_(all)< 0.05). There were no significant differences in the rate of adverse reactions between the two groups during the treatment(P_(all)> 0.05). Conclusion Cimetidine combined with Montelukast sodium in the treatment of Henoch-Schonlein purpura nephritis can effectively improve the level of serum inflammatory factors, renal function and coagulation function, regulate the immune imbalance of Th1/Th2, and the safety is good.
引文
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[19]宗岩,皇玲玲,刘枚,等.芪芎茜根散治疗对小儿紫癜性肾炎免疫三项及淋巴细胞免疫的影响[J].四川中医,2017,35(3):99-101.
[20]唐筱潇,李婷,陈学兰,等.滤泡辅助性T细胞及亚群紊乱参与儿童过敏性紫癜发病机制初探[J].免疫学杂志,2018,34(2):120-127.
[2]付元,常红,陈秀霞.儿童紫癜性肾炎的研究进展[J].青岛大学医学院学报,2016,52(4):496-499.
[3]中华医学会儿科学分会肾脏学组.紫癜性肾炎诊治循证指南(2016)[J].中华儿科杂志,2017,55(9):647-651.
[4]张奕星,袁斌.儿童过敏性紫癜性肾炎的治疗进展[J].医学综述,2014,20(8):1418-1421.
[5]孙智才,杨华彬.免疫抑制剂治疗儿童紫癜性肾炎的进展[J].实用药物与临床,2014,17(3):350-353.
[6]杜妮,李伟明,杨方.糖皮质激素对儿童紫癜性肾炎预防作用的Meta分析[J].临床肾脏病杂志,2014,14(11):651-656.
[7]Lu Z,Song J,Mao J,et al.Evaluation of Mycophenolate Mofetil and Low-Dose Steroid Combined Therapy in Mode rately Severe Henoch-Sch?nlein Purpura Nephritis[J].Med Sci Monit,2017,23(18):2333-2339.
[8]赵娜.血清胱抑素C、表皮生长因子、血管细胞黏附分子-1在儿童紫癜性肾炎诊断中的价值[J].中国临床医生杂志,2016,44(12):48-50.
[9]于斌,宫琦,董健,等.过敏性紫癜患儿Th17、Treg细胞及血清CysC、IL-17、尿NGAL水平与早期肾损伤的相关性研究[J].中国医学前沿杂志(电子版),2018,10(11):16-19.
[10]侯红红,贺改涛,刘丽,等.CTLA-4(AT)n多态性与过敏性紫癜的相关性研究[J].中国妇幼健康研究,2017,28(4):385-388.
[11]李梅爱,谭晓明,邝婉仪,等.尿中微量蛋白和尿N-乙酰-β-D-氨基葡萄糖苷酶的检测对儿童过敏性紫癜肾炎的意义[J].中国卫生检验杂志,2016,26(4):534-535,538.
[12]余燕娟,张迎辉.食物特异性IgG的检测与儿童过敏性紫癜的相关性研究[J].中国儿童保健杂志,2014,22(2):201-204.
[13]陈丽,季宗雯,孙宝光.他克莫司治疗膜性肾病患者疗效及其对血肌酐、血清白蛋白、24h尿蛋白定量等的影响[J].疑难病杂志,2016,15(12):1238-1241.
[14]张媛媛,邓芳.血尿酸水平升高的紫癜性肾炎患儿临床及病理特点[J].山东医药,2018,58(15):79-81.
[15]Wu SH,Liao PY,Chen XQ,et al.Add-on therapy with montelukast in the treatment of Henoch-Sch?nlein purpura[J].Pediatr Int,2014,56(3):315-322.
[16]Tian M,Liu C.Heparin calcium treated Henoch-Sch?n lein purpura nephritis in children through inhibiting hyperfibrinolysis[J].Ren Fail,2015,37(7):1100-1104.
[17]Ye Q,Shang SQ,Liu AM,et al.24h Urinary Protein Levels and Urine Protein/Creatinine Ratios Could Probably Forecast the Pathological Classification of HSPN[J].PLoS One,2015,10(5):e0127767.
[18]林莉,舒素荣.雷公藤联合丹参治疗对紫癜性肾炎患儿肾功能、凝血功能、免疫应答的影响[J].海南医学院学报,2017,23(22):3143-3145.
[19]宗岩,皇玲玲,刘枚,等.芪芎茜根散治疗对小儿紫癜性肾炎免疫三项及淋巴细胞免疫的影响[J].四川中医,2017,35(3):99-101.
[20]唐筱潇,李婷,陈学兰,等.滤泡辅助性T细胞及亚群紊乱参与儿童过敏性紫癜发病机制初探[J].免疫学杂志,2018,34(2):120-127.