儿童狼疮性肾炎多靶点治疗的疗效及安全性  

Efficacy and safety of multiple target therapy for lupus nephritis in children

作　　者：方建[1] 戚畅[1] 祝高红[1] 栾江威[1] 王丹丹[1] 王筱雯[1] 

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)肾内科,430000

出　　处：《中华实用儿科临床杂志》2017年第9期664-667,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：湖北省自然科学基金（2016CFC728）

摘　　要：目的探讨联合应用钙调磷酸酶抑制剂治疗诱导期或维持期对霉酚酸酯耐药的儿童狼疮性肾炎的临床疗效。方法选取华中科技大学同济医学院附属武汉儿童医院2014年2月至2016年9月收治的儿童狼疮性肾炎患儿66例，采用数字随机法随机分为对照组和观察组。其中对照组31例，给予糖皮质激素、环磷酰胺联合的传统疗法进行治疗；观察组35例，给予糖皮质激素、霉酚酸酯、他克莫司（钙调磷酸酶抑制剂）联合应用的多靶点疗法进行治疗。比较2组患儿治疗前后的临床效果及治疗过程中出现的不良反应发生率。结果治疗后，观察组患儿系统性红斑狼疮疾病活动度（SLEDAI）评分、血肌酐、24 h尿蛋白水平[（6.05±1.04）分、（45.08±18.52） μmol/L、（0.96±0.30） g/L]均低于对照组[（11.09±2.33）分、（95.33±36.74） μmol/L、（2.05±0.74） g/L]，差异均有统计学意义（t＝3.097、3.356、3.871，均P〈0.05）。观察组血清补体C3、血浆清蛋白水平[（1.05±0.28） g/L、（63.24±12.98） g/L]均高于对照组[（0.34±0.10） g/L、（35.45±6.74） g/L]，差异均有统计学意义（t＝4.124、3.567，均P〈0.05）。治疗后，2组患儿SLEDAI评分、血肌酐、24 h尿蛋白水平均低于治疗前，血清补体C3、血浆清蛋白水平均高于治疗前，差异均有统计学意义（均P〈0.05）。治疗期间观察组患儿不良反应的发生率（14.29%，5/35例）低于对照组（38.71%，12/31例），差异有统计学意义（χ^2＝5.128，P〈0.05）。结论多靶点联合疗法与传统环磷酰胺疗法均能有效控制儿童狼疮性肾炎，但多靶点联合疗法的临床效果更好，不良反应更少。ObjectiveTo investigate the clinical efficacy of combined use of calcineurin inhibitor in the treatment of lupus nephritis in induction or maintenance, which is resistant to mycophenolate mofetil.MethodsSixty-six cases of children with lupus nephritis were selected from February 2014 to September 2016 in Huazhong University of Science and Technology, Tongji Medical College Affiliated Wuhan Children′s Hospital.The randomized method was used to divide them into the control group and the observation group randomly.Among them, 31 cases in the control group were given glucocorticoid, cyclophosphamide combined with traditional medicine for treatment; 35 cases in observation group were given glucocorticoid, mycophenolate mofetil, tacrolimus （calcine phosphatase inhibitor） multi-target therapy for treatment.The clinical effect of 2 groups before and after treatment were compared, and the incidence of adverse reactions in the treatment of 2 groups of children were compared.ResultsAfter treatment, the levels of systemic lupus erythematosus disease activity index（SLEDAI）, serum creatinine and 24 h urine protein [（6.05±1.04） scores, （45.08±18.52） μmol/L, （0.96±0.30） g/L] in the observation group were lower than those in the control group [（11.09±2.33） scores, （95.33±36.74） μmol/L, （2.05±0.74） g/L], and the differences were statistically significant （t=3.097, 3.356, 3.871, all P〈0.05）. Serum complement C3, plasma albumin levels[（1.05±0.28） g/L, （63.24±12.98） g/L] were higher than those in the control group [（0.34±0.10） g/L, （35.45±6.74） g/L], and the differences were statistically significant （t=4.124, 3.567, all P〈0.05）. After treatment, the levels of serum complement C3 and plasma albumin were significantly higher between 2 groups than those before treatment, the differences were statistically significant （all P〈0.05）. The incidence of adverse reaction （14.29%, 5/35 cases） in the observation group was lower than that in the control group （

关 键 词：钙调磷酸酶抑制剂 狼疮性肾炎 诱导期 维持期 临床疗效 

分 类 号：R725.9[医药卫生—儿科]