摘要
目的观察霉酚酸酯(MMF)治疗儿童过敏性紫癜性肾炎(HSPN)的疗效,研究其对HSPN患儿肾组织Ⅳ型胶原水平的影响,探讨儿童HSPN的最佳治疗方案和作用机制。方法以19例7～13岁确诊的HSPN患儿为研究对象,分为MMF组9例和对照组10例。MMF组开始予泼尼松片1mg/(kg.d),2周后逐渐减量至0.5mg/(kg.d)时予MMF20mg/(kg.d),治疗3个月后MMF逐渐减量至0.25g/d;对照组予泼尼松片1.0～1.5mg/(kg.d),规律减量。2组患儿随访6个月。分别于治疗前及治疗后14d、1个月、3个月、6个月测定其24h尿蛋白定量,血、尿β2-微球蛋白(β2-MG),血浆尿素氮,肌酐,清蛋白等指标。并取其肾组织行常规肾脏病理检查,免疫组织化学染色对肾组织Ⅳ型胶原图像进行定量分析,其中MMF组3例、对照组4例于治疗后行肾活检,余患儿均在治疗前行肾活检。结果1.治疗3、6个月,MMF组尿蛋白定量分别为(0.6±0.6)、(0.4±0.5)g/24h,均较治疗前[(2.4±1.6)g/24h]明显减少(Pa<0.01),清蛋白分别为(45±4)、(45±4)g/L,较治疗前(35±7)g/L均明显升高(Pa<0.01);对照组尿蛋白定量分别为(1.2±0.8)、(1.0±0.7)g/24h,均较治疗前[(2.3±1.5)g/24h]减低(Pa<0.05),但降低的幅度没有MMF组显著,二组比较差异有统计学意义(P<0.05);而清蛋白分别为(41±4)、(43±5)g/L,与治疗前[(35±6)g/L]比较均明显升高(Pa<0.01),2组间比较无明显差异(P>0.05)。2.治疗3、6个月,MMF组总蛋白分别为(70±8)、(71±7)g/L,较治疗前[(58±10)g/L]均明显升高(Pa<0.01);对照组总蛋白分别为(69±6)、(68±6)g/L,较治疗前[(58±9)g/L]均明显升高(Pa<0.01),2组比较差异无统计学意义(P>0.05)。3.二组治疗前后及组间比较,血、尿β2-MG均无显著性差异(Pa>0.05)。4.MMF组3例和对照组4例治疗后肾组织Ⅳ型胶原水平(%)比较有统计学意义(P<0.01)。结论MMF联合激素治疗降低HSPN患儿尿蛋白的幅度优于激素疗法,能明显减弱因过敏性紫癜而造成肾组织Ⅳ型胶原的表达。
Objective To study the efficacy of mycophemolatemofeil （MMF） on Henoch-Schonlein purpura nephritis（HSPN） and investigate the effects of MMF on the levels of renal type Ⅳ collagen,and to explore the best therapy and mechanism.Methods Taking 19 children with HSPN as objectives,and the children were randomly divided into MMF group（10 cases） and control group（9 cases）.The MMF group was cured by prednisone with 1 mg/（kg·d ）at first,then the dosage was reduced to 0.5 mg/（kg·d） after 3 months,and finally cured by using MMF with 20 mg/（kg·d）.The dosage of MMF was reduced to 0.25 g/d 3 months later.The control group was cured by using prednisone with 1.0-1.5 mg/（kg·d）,then the dosage of prednisone was reduced regularly.Blood and urinary tests,hepatic and renal function,plasma-albumin,24 h protein excretion,blood and urinary β2-microglobulin（β2-MG） were performed previously,14 days and 1,3,6 months after treatments in both groups.Three children in MMF group and 4 children in control group received repeated renal biopsy.Results 1.After 3,6 months treatment,decrease of urinary protein[（0.6±0.6）,（0.4±0.5） g/24 h vs （2.4±1.6） g/24 h Pa0.01）] and improvement of plasma albumin[（45±4）,（45±4） g/L vs （35±7） g/L Pa0.01）] were observed in MMF group,while in control group,decrease of urinary protein was found in urinary protein[（1.2±0.8）,（1.0±0.7） g/24 h vs （2.3±1.5） g/24 h Pa〈0.05）],but the range of decrease was less than that in MMF group,and significance was observed in control group compared with MMF group（P〈0.05）.And improvement of plasma albumin in control group[（41±4）,（43±5） g/L vs （35±6） g/L Pa〈0.05）],so no significance was observed in control group compared with MMF group （P〉0.05）.2.Serum total protein were remarkably increased after 3,6 months treatment in MMF group and control group,and no significance was observed in control group compared with MMF group （P〉0.05）.3.No significance of serum a
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2009年第23期1826-1828,共3页
Journal of Applied Clinical Pediatrics
基金
安徽省自然科学基金项目资助(070413254X)
关键词
霉酚酸酯
过敏性紫癜性肾炎
Ⅳ型胶原
儿童
mycophemolatemofeil
Henoch-Schonlein purpura nephritis
type Ⅳ collagen
child
