摘要
目的:探讨甲泼尼龙脉冲(MDP)联合吗替麦考酚酯(MMF)治疗儿童系统性红斑狼疮(SLE)的疗效及不良反应。方法:选择16例临床诊断为SLE、狼疮性肾炎(LN)、病理分级均为Ⅳ型弥漫性球性增生性肾小球肾炎的患儿,其中7例采用MDP联合MMF治疗,冲击间歇期口服小剂量糖皮质激素(GC),作为脉冲治疗组;9例采用口服GC移行减量治疗,作为传统治疗组。疗效评价系统为狼疮疾病活动指数(SLEDAI),分析2组患儿体质量指数(BMI)、眼压(IOP)、甘油三酯(TG)、空腹血糖(FBG)、血压(BP)和血钙(Ca),比较2组患儿治疗1年内的疗效及不良反应。结果:治疗后脉冲治疗组SLEDAI评分、补体C3和补体C4水平、24h尿蛋白定量均优于传统治疗组,其中治疗后3和6个月SLEDAI评分2组间比较差异有统计学意义(P<0.05),治疗后6个月血沉(ESR)和24h尿蛋白定量2组间比较差异有统计学意义(P<0.05),治疗后6和12个月补体C3水平2组间比较差异有统计学意义(P<0.05)。脉冲治疗组患儿治疗后BMI、IOP、TG和FBG低于传统治疗组,治疗后12个月BMI、IOP和TG水平2组间比较差异有统计学意义(P<0.05),治疗后6和12个月FBG水平比较差异有统计学意义(P<0.05)。脉冲治疗组患儿Ca高于传统治疗组,但差异无统计学意义(P>0.05)。治疗后脉冲治疗组患儿收缩压(SBP)及舒张压(DBP)高于传统治疗组,但差异无统计学意义(P>0.05)。2组患儿均未发生消化道溃疡、出血、穿孔,胰腺炎和心血管事件(如心律失常)等并发症。结论:与传统治疗方法比较,MDP联合MMF治疗SLE可早期快速控制症状,减轻脏器损害。以治疗1年为观察截点,其疾病活动度低于传统治疗,疗效优于口服GC移行减量联合免疫抑制剂治疗。且GC相关不良反应更少。
Objective:To investigate the efficacy and side effects of combination of methylprednisolone pulse(MDP)and mycophenolate mofetil(MMF)in the treatment of systemic lupus erythematosus(SLE)in the children.Methods:A total of 16 cases of children with SLE,lupus nephritis(LN)and typeⅣdiffuse glomerular mesangial proliferative glomerulonephritis diagnosed by pathology were selected.Among them 7 cases were given MDP combined with MMF,and received intermittently oral small dose of corticosteroids(GC),and they were used as pulse therapy group;9 cases were given oral GC and transitional reduction,and they were used as traditional therapy group.SLEDAI was used for the evaluation of the curative effect,and body mass index(BMI),blood pressure(BP),intraocular pressure(IOP),triglycerides(TG),fasting blood glucose(FBG)and serum calcium(Ca)were analyzed during the treatment of 1 year and then the efficacies and side effects of the children in two groups were compared.Results:The SLEDAI scores,levels of complements C3 and C4,24 h urinary protein outcome of the children in pulse therapy group were better than those in traditional therapy group;the differences in SLEDAI scores were statistically significant after treating for 3 and 6 months between two groups(P<0.05);ESR and 24 h urinary protein outcome had significant differences after 6 months of treatment between two groups(P<0.05);the complement C3 difference was statistically significant between two groups(P<0.05)after 12 months of treatment.Compared with traditional therapy group,the BMI,IOP,TG,FBG of the children in pulse therapy group after treatment were decreased(P<0.05);the BMI,IOP and TG had significant differences after treating for 12 months between two groups(P<0.05);the differences in FBG were statistically significant after treating for 6 and 12 months between two groups(P<0.05).The Ca of the patients in pulse therapy group was higher than that in traditional therapy group,but there was no statistically significant difference(P>0.05).The SPB and DBP of the patients
作者
郭丽双
刘金香
王晶华
潘璐
徐萌
刘聪聪
杨思睿
GUO Lishuang;LIU Jinxiang;WANG Jinghua;PAN Lu;XU Meng;LIU Congcong;YANG Sirui(Department of Pediatric Rheumatology-Immunology and Allergy,First Hospital,Jilin University,Changchun 130021,China)
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2018年第2期368-373,共6页
Journal of Jilin University：Medicine Edition
基金
吉林省科技厅自然科学基金资助课题(20160101065JC)
关键词
甲泼尼龙脉冲
吗替麦考酚酯
系统性红斑狼疮
狼疮性肾炎
儿童
methylprednisolone pulse
mycophenolate mofetil
systemic lupus erythematosus
lupus nephritis
children
