[关键词]
[摘要]
目的 探讨环磷酰胺联合卡托普利、甲泼尼龙在小儿Ⅲ~Ⅳ级紫癜性肾炎中的应用价值。方法 选取2019年1月—2020年1月屯昌县人民医院治疗的紫癜性肾炎患儿94例作为研究对象,依据治疗方法将患者分为对照组与观察组,每组各47例。对照组口服卡托普利片,0.5 mg/kg,3次/d;同时注射用甲泼尼龙琥珀酸钠,10~20 mg/kg加入5%葡萄糖溶液100~200 mL,隔天冲击1次,3次为1个疗程。观察组在对照组治疗的基础上给予注射用异环磷酰胺,10 mg/kg加入0.9%氯化钠溶液250 mL,于2 h内静脉泵注,1次/d,连用2 d为l个疗程,每隔3周重复1次,共冲击治疗6个疗程。两组均持续治疗6个月。观察两组患者的临床疗效,同时比较两组临床症状缓解时间、肾功能指标、肾小管间质病理分级情况及血清白细胞介素-8(IL-8)和血管细胞黏附分子-1(VCAM-1)水平。结果 治疗后,对照组和观察组的总有效率分别为76.60%、91.49%,两组比较差异有统计学意义(P<0.05)。治疗后,观察组关节痛、腹痛、便血或黑便及紫癜消失时间显著短于对照组(P<0.05)。治疗3、6个月后,两组血清血肌酐(SCr)、尿素氮(BUN)、尿微量蛋白(mAlb)、24 h尿蛋白定量较治疗前显著降低,且观察组显著低于对照组同期(P<0.05)。治疗后,观察组肾小管间质病理分级优于对照组(P<0.05)。治疗3、6个月后,两组血清IL-8、VACM-1水平较治疗前降低(P<0.05),且观察组显著低于同期对照组(P<0.05)。结论 环磷酰胺联合卡托普利、甲泼尼龙治疗小儿Ⅲ~Ⅳ级难治性紫癜性肾炎可下调IL-8、VCAM-1水平,改善肾小管间质病理分级,在合理用药基础上不良反应少,治疗效果显著。
[Key word]
[Abstract]
Objective To explore the application value of cyclophosphamide combined with captopril and methylprednisolone in children with grade Ⅲ — Ⅳ purpura nephritis. Methods A total of 94 children with purpura nephritis treated in People's Hospital of Tunchang County from January 2019 to January 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 47 cases in each group. Patients in the control group were po administered with Captopril Tablets, 0.5 mg/kg, three times daily. And injected with Methylprednisolone Sodium Succinate for Injection,10 — 20 mg/kg was added with 5% glucose solution 100 — 200 mL, and the solution was injected once every other day, three times as a course of treatment. Patients in the observation group were given Ifosfamide for Injection on the basis of control group, 10 mg/kg added with 250 mL 0.9% sodium chloride solution, intravenously pumped within 2 h, once a day, for 2 days as a course of treatment, repeated every 3 weeks, for a total of 6 courses of shock therapy. Both groups were treated continuously for 6 months. The clinical efficacy of two groups was observed, and the duration of clinical symptom remission, renal function indexes, renal tubulointerstitial pathological grading, and serum levels of IL-8 and VCAM-1 were compared between two groups. Results After treatment, the total effective rate of the control group and the observation group was 76.60% and 91.49%, respectively, and the difference between two groups was statistically significant (P < 0.05). After treatment, the disappearance time of arthralgia, abdominal pain, hemochezia or melena and purpura in the observation group was significantly shorter than that in the control group (P < 0.05). After 3 months and 6 months of treatment, the levels of serum SCR, BUN, mALB, and 24 h urinary protein in two groups were significantly decreased compared with before treatment, and the observation group was significantly lower than the control group (P < 0.05). After 6 months of treatment, the pathological grading of renal tubulointerstitial in the observation group was better than that in the control group (P < 0.05). After 3 and 6 months of treatment, the levels of serum IL-8 and VACM-1 in two groups were lower than before treatment (P < 0.05), and the observation group was significantly lower than the control group (P < 0.05). Conclusion Cyclophoshamide combined with captopril and methylprednylone in treatment of children with Ⅲ — Ⅳ grade purpura nephritis can downregulate the levels of IL-8 and VCAM-1, and improve the pathological grade of renal tubulointerstitial. On the basis of rational drug use, there are fewer adverse reactions, and the therapeutic effect is significant.
[中图分类号]
R984
[基金项目]
海南省卫生计生行业科研项目(18A200051)