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[摘要]
目的 探讨使用他克莫司治疗难治性肾病综合征患儿的临床效果以及对患儿体内调节性T细胞(Regulatory T cells,Tregs)的影响。方法 将西安市儿童医院自2012年1月—2017年1月收治的难治性肾病综合征患儿120例作为研究对象,随机分为研究组(n=60)和对照组(n=60);研究组患儿选择他克莫司进行治疗,对照组采用环磷酰胺治疗,两组均治疗6个月。观察并记录两组患儿的临床疗效和治疗前后Treg细胞水平、尿蛋白定量、血清白蛋白、血肌酐、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、胆固醇、三酰甘油等指标的水平变化情况。结果 研究组患儿治疗的临床总有效率为95.00%,明显高于对照组的71.67%,差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后CD4+/CD25+显著上升(P<0.05),同时研究组显著高于对照组(P<0.05)。治疗后,研究组和对照组患儿24 h尿蛋白定量水平均显著低于治疗前(P<0.05),且研究组显著低于对照组(P<0.05);两组治疗后血清白蛋白水平均显著升高(P<0.05),且研究组显著高于对照组(P<0.05)。但两组治疗前后血肌酐水平比较差异不显著,两组患儿治疗前后ALT和AST水平比较差异不显著。治疗后,研究组和对照组胆固醇、三酰甘油显著低于治疗前(P<0.05),并且研究组胆固醇、三酰甘油含量显著低于对照组(P<0.05)。结论 他克莫司治疗难治性肾病综合征患儿可有效提高患儿体内Treg比例,调节患儿免疫失衡,改善患儿的肾功能和血脂水平,安全有效,具有较好的临床推广使用价值。
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[Abstract]
Objective To investigate the clinical efficacy of tacrolimus in the treatment of children with refractory nephrotic syndrome (Regulatory) and its influence on T cells (Tregs) in children. Methods the failure of conventional hormone therapy in our hospital from January 2012 to January 2017 were of the refractory nephrotic syndrome with 120 cases as the research object, Were randomly divided into 2 groups:Study Group (n=60) and control group (n=60), Study Groupwas chosen for tacrolimus treatment, and control group was treated by cyclophosphamide. Before and after treatment were measured with 24h urine protein, serum albumin, serum creatinine, alanine aminotransferase, aspartate the amino acid amino shift enzyme, the level of cholesterol and triglyceride in the index. Results The total effective rate of the treatment group was 95%, which was significantly higher than that of the control group (71.67%, P < 0.01). Compared with before treatment, the CD4+/CD25+ of the two groups increased significantly (P < 0.01), and the study group was significantly higher than the control group (P < 0.05). After treatment, the study group and the control group with 24 h urinary protein levels were significantly lower than before treatment, and the study group was significantly lower than the control group (P < 0.05), the serum albumin levels in two group were significantly increased after treatment, and the study group was significantly higher than control group (P < 0.05). Before and after treatment the level of serum creatinine in two groups was not significant. Before and after treatment in the two groups the level of ALT and AST were not significantly different. After treatment, the study group and the control group of cholesterol, triglyceride was significantly lower than that before treatment (P < 0.05) and, cholesterol, triglyceride content in study group were significantly lower than control group (P < 0.05). Conclusion tacrolimus in the treatment of refractory nephrotic syndrome in children can effectively improve the proportion of children in children with Treg, regulating immune imbalance, improve renal function and blood lipid levels, is safe and effective, has good clinical application value.
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