强化免疫抑制方案治疗难治性肾病综合征的临床观察  

Clinical Observation of Enhanced Immunosuppressive Therapy in the Treatment of Refractory Nephrotic Syndrome

作　　者：史添立[1] 罗贞[1] 焦石[2] 

机构地区：[1]海口市人民医院肾病风湿科,海口570208 [2]中山市博爱医院肾病风湿科,广东中山528400

出　　处：《中国药房》2017年第23期3237-3240,共4页China Pharmacy

摘　　要：目的:观察强化免疫抑制方案治疗难治性肾病综合征(RNS)的临床效果及安全性。方法:选取笔者所在2家医院2012年1月-2015年3月收治的RNS患者76例,采用随机数字表法分为对照组和观察组,各38例。两组患者均给予醋酸泼尼松片50mg,qd;待尿蛋白恢复至正常后减量至15 mg,qd维持。在此基础上,对照组患者给予来氟米特片50 mg,qd;3 d后减量至20 mg,qd维持。观察组患者在对照组基础上加用吗替麦考酚酯分散片750 mg,bid;3个月后减量至500 mg,qd维持。两组患者均治疗6个月。比较两组患者的临床疗效、随访复发率、治疗前后的肾功能指标和炎症细胞因子指标,以及不良反应发生情况。结果:观察组患者的总有效率(92.11%)显著高于对照组(73.68%),随访复发率(5.26%)显著低于对照组(23.68%),差异均有统计学意义(P<0.05)。治疗前,两组患者的肾功能指标和炎症细胞因子指标比较,差异均无统计学意义(P>0.05);治疗后,两组患者的24 h尿蛋白定量、尿白细胞介素6(IL-6)和IL-8水平均较治疗前显著降低,血清白蛋白含量较治疗前显著升高,且观察组指标水平显著优于对照组,差异均有统计学意义(P<0.05);两组患者治疗前后血肌酐含量比较,差异均无统计学意义(P>0.05)。对照组和观察组患者的不良反应发生率分别为34.21%和44.74%,组间比较差异无统计学意义(P>0.05)。结论:强化免疫抑制方案治疗RNS可有效改善患者肾功能,降低炎症反应水平和远期复发风险,临床疗效较好且安全性较高。OBJECTIVE：To observe the clinical efficacy and safety of enhanced immunosuppressive therapy in the treatment of refractory nephrotic syndrome（RNS）. METHODS： Totally 76 RNS patients were selected from 2 hospitals during Jan.2012-Mar. 2015,and then divided into control group and observation group according to random number table,with 38 cases in each group. Two groups were given Prednisone acetate tablet 50 mg,qd;decreasing to 15 mg,qd,after urine protein returned to normal. Based on it,control group was given Leflunomide tablets 50 mg,qd;decreasing to 20 mg,qd,3 days later. Based on control group,observation group was additionally given Mycophenolate mofetil dispersible tablet 750 mg,bid;decreasing to 500 mg,qd,3 months later. Both groups were treated for 6 months. Clinical efficacies,follow-up recurrence rate as well as renal function indexes and inflammatory cell factors before and after treatment,and the occurrence of ADR were compared between 2 groups. RESULTS：The total response rate of observation group（92.11%） was significantly higher than control group（73.68%）,and follow-up recurrence rate（5.26%）was significantly lower than control group（23.68%）,with statistical significance（P〈0.05）. Before treatment,there was no statistical significance in renal function indexes or inflammatory cell factors between 2 groups（P〈0.05）. After treatment,24 h urinary protein quantification,urinary IL-6 and IL-8 levels of 2 groups decreased significantly,while the content of serum protein increased significantly;the observation group was significantly better than the control group,with statistical significance（P〈0.05）. There was no statistical significance in the content of serum creatinine between 2 groups before and after treatment（P〈0.05）. The incidence of ADR in the control group and the observation group was 34.21% and 44.74% respectively,without statistical significance between 2 groups（P〈0.05）. CONCLUSIONS：Enhanced immunosuppressive therapy in the treatment of RNS c

关 键 词：强化免疫抑制方案 免疫抑制剂 难治性肾病综合征 糖皮质激素 来氟米特 吗替麦考酚酯 肾功能 复发风险 药品不良反应 

分 类 号：R459.9[医药卫生—治疗学]