吗替麦考酚酯联合糖皮质激素对过敏性紫癜性肾炎患儿肾功能及免疫功能的影响
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摘要
目的探讨吗替麦考酚酯联合糖皮质激素治疗过敏性紫癜性肾炎患儿的临床疗效,以及对机体肾功能和免疫功能的影响。方法将140例过敏性紫癜性肾炎急性期患儿分为研究组和对照组。所有患儿均给予常规对症及泼尼松+环磷酰胺治疗,而研究组患儿在泼尼松片剂量减低至0.5 mg/(kg·天)时加用吗替麦考酚酯而不给予环磷酰胺治疗。记录治疗前及治疗6个月后患儿肾功能指标、免疫功能指标以及治疗过程中的不良反应。结果治疗6个月后,与治疗前比较,两组患儿尿红细胞、24小时UPRO、β2-MG、MA水平及血清CD4`+/CD8~+、IgA均明显降低,血清CD3~+、CD4~+及CD8~+均明显升高(除对照组血清CD4~+外);研究组总有效率、血清CD3~+均较对照组明显升高,而尿红细胞、24小时UPRO、β2-MG、MA水平及血清CD4~+/CD8~+、IgA均较对照组明显降低,以上差异均有统计学意义(P<0.05)。研究组患儿不良反应总发生率低于对照组,但差异无统计学意义(P>0.05)。结论吗替麦考酚酯与糖皮质激素激素联用治疗不仅能在一定程度上提高小儿过敏性紫癜性肾炎的临床疗效,而且对患儿肾功能及免疫功能的恢复具有一定的促进作用,并能在一定程度上降低环磷酰胺所致的不良反应发生率,值得临床推广。
Objective To investigate the clinical efficacy of mycophenolate mofetil combined with glucocorticoid in the treatment of Henoch-Schonlein purpura nephritis and its effect on renal function and immune function. Methods 140 children with Henoch-Schonlein purpura nephritis in acute stage were divided into study group and control group. All the children were given routine treatment of symptomatic and prednisone + cyclophosphamide. In the study group, when the dosage of prednisone tablets was reduced to 0.5 mg/(kg.days), the children in the study group were given mycophenolate mofetil instead of cyclophosphamide. The indexes of renal function, immune function and adverse reaction during treatment were recorded before and 6 months after treatment. Results After 6 months of treatment, the levels of 24-hour UPRO, β2-MG, MA, serum CD4/CD8, IgA and serum CD3, CD4 and CD8 were significantly increased in the two groups(except for the control group CD4+) as compared with those before treatment. The total effective rate and serum CD3 in the study group were significantly higher than those in the control group, while the urinary erythrocytes, 24-hour UPRO, β2-MG,MA level, serum CD4/CD8 and IgA were significantly lower than those in the control group(P<0.05). The total incidence of adverse reactions in the study group was lower than that in the control group, but there was no significant difference(P>0.05). Conclusion The combination of mycophenolate mofetil and glucocorticoid can not only improve the clinical effect of Henoch-Schonlein purpura nephritis in a certain extent, but also promote the recovery of renal function and immune function in children with Henoch-Schonlein purpura nephritis. It can reduce the incidence of adverse reactions caused by cyclophosphamide to a certain extent, which is worthy of clinical popularization.
Objective To investigate the clinical efficacy of mycophenolate mofetil combined with glucocorticoid in the treatment of Henoch-Schonlein purpura nephritis and its effect on renal function and immune function. Methods 140 children with Henoch-Schonlein purpura nephritis in acute stage were divided into study group and control group. All the children were given routine treatment of symptomatic and prednisone + cyclophosphamide. In the study group, when the dosage of prednisone tablets was reduced to 0.5 mg/(kg.days), the children in the study group were given mycophenolate mofetil instead of cyclophosphamide. The indexes of renal function, immune function and adverse reaction during treatment were recorded before and 6 months after treatment. Results After 6 months of treatment, the levels of 24-hour UPRO, β2-MG, MA, serum CD4/CD8, IgA and serum CD3, CD4 and CD8 were significantly increased in the two groups(except for the control group CD4+) as compared with those before treatment. The total effective rate and serum CD3 in the study group were significantly higher than those in the control group, while the urinary erythrocytes, 24-hour UPRO, β2-MG,MA level, serum CD4/CD8 and IgA were significantly lower than those in the control group(P<0.05). The total incidence of adverse reactions in the study group was lower than that in the control group, but there was no significant difference(P>0.05). Conclusion The combination of mycophenolate mofetil and glucocorticoid can not only improve the clinical effect of Henoch-Schonlein purpura nephritis in a certain extent, but also promote the recovery of renal function and immune function in children with Henoch-Schonlein purpura nephritis. It can reduce the incidence of adverse reactions caused by cyclophosphamide to a certain extent, which is worthy of clinical popularization.
引文
[1]张奕星.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.
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[11]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.
[12]莫晓露.吗替麦考酚酯与泼尼松联用对儿童紫癜性肾炎患者的临床效果分析[J].临床医学工程,2017,24(4):519-520.
[13]段文冰,鞠瑛,沈亚娟,等.儿童过敏性紫癜血中标志物的检测及临床意义[J].中国医药,2017,12(2):285-289.
[14]Castellino F,Germain RN.Cooperation between CD4+and CD8+T cells:when,where,and how[J].Annu Rev Immunol,2006(24):519-540.
[15]付强,封其华,宋晓翔,等.紫癜性肾炎患儿CD4+CD25+调节性T细胞和淋巴细胞亚群变化的意义[J].实用儿科临床杂志,2009,24(5):373-374.
[16]邢静,李文斌,王艳飞,等.儿童过敏性紫癜血清IL-21、TGF-β1、TNF-α、IgA1的变化与紫癜性肾炎发生的相关性研究[J].基因组学与应用生物学,2017,36(7):2633-2639.
[2]秦艳巧,袁斌.儿童过敏性紫癜性肾炎中医药治疗进展[J].辽宁中医药大学学报,2016,20(5):139-142.
[3]赵建辉,何红权.过敏性紫癜肾炎诊治进展[J].中国中西医结合肾病杂志,2013,14(4):363-365.
[4]张洲,杜悦.吗替麦考酚酯在儿童肾脏疾病中的应用[J].国际儿科学杂志,2016,43(12):716-718.
[5]中华医学会儿科学分会肾脏病学组.小儿肾小球疾病的临床分类、诊断及治疗[J].中华儿科杂志,2001,39(12):746-749.
[6]郑筱萸.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:212-213.
[7]张爱华,朱春华.儿童紫癜性肾炎诊治进展[J].中华实用儿科临床杂志,2017,32(5):324-327.
[8]薛雪,王小琴,邹新蓉,等.过敏性紫癜性肾炎(紫癜肾)的中医药诊疗进展[J].四川中医,2017,2(11):215-218.
[9]姜松,虎春元吗替麦考酚酯与环磷酰胺联合泼尼松治疗儿童紫癜性肾炎疗效对比[J].河北医学,2016,22(3):464-467.
[10]田建梅,刘晓伟.吗替麦考酚酯联合泼尼松治疗小儿紫癜性肾炎的效果[J].中国医药导报,2016,13(24):117-120.
[11]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.
[12]莫晓露.吗替麦考酚酯与泼尼松联用对儿童紫癜性肾炎患者的临床效果分析[J].临床医学工程,2017,24(4):519-520.
[13]段文冰,鞠瑛,沈亚娟,等.儿童过敏性紫癜血中标志物的检测及临床意义[J].中国医药,2017,12(2):285-289.
[14]Castellino F,Germain RN.Cooperation between CD4+and CD8+T cells:when,where,and how[J].Annu Rev Immunol,2006(24):519-540.
[15]付强,封其华,宋晓翔,等.紫癜性肾炎患儿CD4+CD25+调节性T细胞和淋巴细胞亚群变化的意义[J].实用儿科临床杂志,2009,24(5):373-374.
[16]邢静,李文斌,王艳飞,等.儿童过敏性紫癜血清IL-21、TGF-β1、TNF-α、IgA1的变化与紫癜性肾炎发生的相关性研究[J].基因组学与应用生物学,2017,36(7):2633-2639.