[关键词]
[摘要]
目的 探讨环孢素联合泼尼松治疗肾病综合征患儿的临床疗效。方法 选择新疆喀什地区第一人民医院2016年1月-2018年12月收治的原发性肾病综合征患儿96例作为研究对象,随机分为对照组和观察组,每组各48例。两组患儿给予醋酸泼尼松片进行治疗,0.5 mg/(kg·d),最大剂量不超过60 mg/d,最长使用8周后逐渐减少使用剂量,减至起始剂量的2/3,隔日晨顿服。对照组患儿静脉滴注注射用环磷酰胺,使用剂量为8~12 mg/(kg·d),1次/月。观察组患者分次口服环孢素软胶囊,使用剂量3~5 mg/(kg·d),开始用药后7~10 d根据患者血药浓度调整剂量,诱导缓解期血药浓度为72 μg/L,尿蛋白转阴后可减少使用剂量,维持缓解期的血药浓度为40 μg/L。两组均治疗3个月。观察两组患者的临床疗效,同时比较两组患儿治疗前后的免疫功能相关指标和肾功能指标水平。结果 治疗后,观察组总缓解率为91.67%,明显高于对照组的72.92%(P<0.05)。治疗后,两组CD4+水平明显升高,CD8+、干扰素(INF-γ)、白细胞介素(IL)-4、IL-6水平均降低(P<0.05),且观察组的免疫指标改善程度更显著(P<0.05)。治疗后,两组血肌酐(Scr)、尿素氮(BUN)水平均降低,肌酐清除率(Ccr)水平明显升高(P<0.05),且观察组肾功能指标改善程度更显著(P<0.05)。结论 环孢素联合泼尼松治疗肾病综合征的疗效优于环磷酰胺联合泼尼松,可改善患者免疫功能和肾功能,安全性好,可在临床范围内推广使用。
[Key word]
[Abstract]
Objective To investigate the clinical effects of ciclosporin combined with prednisone. Methods A total of 96 children with primary nephrotic syndrome admitted to First People's Hospital of Kashgar Area from January 2016 to December 2018 were selected as study subjects, and randomly divided into a control group and an observation group, with 48 patients in each group. Children in two groups were treated with Prednisone Acetate Tablets, 0.5 mg/(kg·d), the maximum dose not exceeding 60 mg/d. The maximum dose was reduced gradually after 8 weeks of use, and was reduced to 2/3 of the initial dose. Children in two groups were given Prednisone Acetate Tablets every other day in the morning. Children in the control group were iv administered with Cyclophosphamide for Injection at the dosage of 8-12 mg/(kg·d), once per month. Children in the observation group were po administered with Ciclosporin Soft Capsules for 3-5 mg/(kg·d), and the dose was adjusted according to the patient's blood concentration for 7 to 10 days after the treatment. The blood concentration in the induced remission period was 72 μg/L, and the dose could be reduced after the urine protein turned negative, and the blood concentration in the maintenance remission period was 40 μg/L. Both groups were treated for 3 months. The clinical efficacy of the two groups of patients was observed, and the immune function related indexes and renal function indexes of two groups were compared before and after treatment. Results After treatment, the total remission rate in the observation group was 91.67%, which was significantly higher than 72.92% in the control group (P<0.05). After treatment, CD4+ level was significantly increased in two groups, but CD8+, INF-γ, IL-4, and IL-6 levels were all decreased (P<0.05), and the improvement of immune indexes in the observation group was more significant (P<0.05). After treatment, Scr and BUN levels in two groups were decreased, Ccr level was significantly increased (P<0.05), and the improvement degree of renal function index in the observation group was more significant (P<0.05). Conclusion Ciclosporin combined with prednisone is more effective than cyclophosphamide combined with prednisone in treatment of nephrotic syndrome. It can improve the immune function and renal function of patients, and it is safe and can be widely used in the clinical scope.
[中图分类号]
R979.5
[基金项目]