摘要
目的观察霉酚酸酯(mycophenolate mofetil,MMF)与环孢素A(cyclosporine A,CsA)分别联合泼尼松治疗原发性难治性肾病综合征的效果及安全性。方法回顾性分析德阳市人民医院给予MMF联合泼尼松治疗(MMF组,42例)及CsA联合泼尼松治疗(CsA组,46例)的原发性难治性肾病综合征患儿临床资料,2组均在治疗3个月时评估临床疗效,治疗无效患儿予以停药。记录2组治疗3个月时临床疗效、治疗12个月时治疗有效患儿复发率及治疗期间不良反应发生情况,并比较2组治疗有效患儿治疗前及治疗3、6、12个月时尿液肾损伤分子1(kidney injury molecule 1,KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)及外周血T淋巴细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)差异。结果治疗3个月,CsA组临床疗效均优于MMF组(P<0.05);治疗12个月时,CsA组治疗有效患儿复发率明显低于MMF组(P<0.05)。2组呼吸道感染、消化道反应、急性肾损伤、高血压发生率比较,差异无统计学意义(P>0.05);但MMF组毛发及齿龈增生发生率低于CsA组(P<0.05)。2组治疗有效患儿治疗前后尿液KIM-1、NGAL变化情况均为治疗前>治疗12个月>治疗6个月>治疗3个月(P<0.05);2组治疗12个月时,尿液KIM-1、NGAL比较,差异无统计学意义(P>0.05);但治疗3个月、6个月时,MMF组尿液KIM-1、NGAL均高于CsA组(P<0.05)。2组治疗有效患儿治疗前后组间及组内外周血CD8^+比较,差异均无统计学意义(P>0.05);2组治疗3、6、12个月时,外周血CD4^+、CD4^+/CD8^+均较治疗前降低(P<0.05),但治疗后各时间点比较,差异均无统计学意义(P>0.05);治疗3、6、12个月时,MMF组外周血CD4^+、CD4^+/CD8^+均高于CsA组(P<0.05)。结论 MMF、CsA联合泼尼松治疗原发性难治性肾病综合征均具有良好疗效及安全性,CsA临床疗效优于MMF,但引起毛发及齿龈增生较多,治疗过程中需监测血药浓度,避免急性肾损伤发生。
Objective To observe the effects and safety of mycophenolate mofetil(MMF)or cyclosporine A(CsA)combined with prednisone in the treatment of primary refractory nephrotic syndrome.Methods Retrospective analysis was conducted of the clinical data of children with primary refractory nephrotic syndrome treated with MMF combined with prednisone(MMF group,42 cases)or with CsA combined with prednisone(CsA group,46 cases).Theclinical efficacy was evaluated afterthree months of treatment,and patients whose treatment failed to work discontinued medication.The clinical efficacy afterthree months of treatment,recurrence rate among childrenaftertwelve months of effective treatment and incidence of adverse reactions during treatment were recorded in the two groups.The levels of kidney injury molecule 1(KIM-1),neutrophil gelatinase-associated lipocalin(NGAL)and peripheral blood T lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)before treatment,at 3 months,6 months and 12 months of treatment were compared between childrenunder effective treatment in the two groups.Results At 3 months of treatment,the clinical efficacy ofCsA group was better than that of MMF group(P<0.05).At 12 months of treatment,the recurrence rate among children under effective treatment in CsA group was significantly lower than in MMF group(P<0.05). There was no significant difference in the incidence of respiratory tract infection, digestive tract reaction, acute kidney injury or hypertension between the two groups(P>0.05). However, the incidence of hair and gingival hyperplasia in MMF group was lower than in CsA group(P<0.05). The changes of urine KIM-1 and NGAL among children under effective treatment gradually decreased(P<0.05). After 12 months of treatment, there was no significant difference in the levels of urine KIM-1 and NGAL between the two groups(P>0.05). However, at 3 months and 6 months of treatment, the levels of KIM-1 and NGAL in MMF group were higher than those in CsA group(P<0.05). There was no significant difference in the levels of peripheral blood C
作者
罗丹
詹璐
LUO Dan;ZHAN Lu(Department of Pediatrics,People's Hospital of Deyang City,Deyang Sichuan 618000,China)
出处
《空军医学杂志》
2020年第6期492-496,共5页
Medical Journal of Air Force
基金
四川省卫生厅科研基金项目(130173)。
关键词
原发性难治性肾病综合征
霉酚酸酯
环孢素A
泼尼松
不良反应
primary refractorynephrotic syndrome
mycophenolate mofetil
cyclosporine A
prednisone
adverse reactions
