环孢素联合小剂量糖皮质激素对PLA2 R阳性膜性肾病患者疗效及T淋巴细胞亚群的影响观察  

Effect of Cyclosporine A Combined with Small Dose of Glucocorticoid on the Efficacy and T Lymphocyte Subsets of Patients with PLA2R Positive Membranous Nephropathy

作　　者：姚杏[1] 聂丽敏 张珊珊 赵研哲 薛兰芬[1] Yao Xing;Nie Limin;Zhang Shanshan;Zhao Yanzhe;Xue Lanfen(Department of Nephrology,Shijiazhuang First Hospital,Shijiazhuang 050000,China;Department of Orthopaedics,Shijiazhuang Third Hospital)

机构地区：[1]石家庄市第一医院肾内科,石家庄050000 [2]石家庄市第三医院骨科

出　　处：《中国药师》2020年第5期891-894,共4页China Pharmacist

基　　金：石家庄市科学技术研究与发展指导计划项目(编号:191460523)。

摘　　要：目的:观察环孢素(CsA)联合小剂量糖皮质激素治疗抗M型磷脂酶A2受体(PLA2R)阳性膜性肾病(MN)的疗效,及对患者T淋巴细胞亚群的影响。方法:100例血清PLA2R抗体阳性的MN门诊患者随机分为对照组和观察组各50例。对照组给予醋酸泼尼松片联合环磷酰胺(CTX)治疗,观察组给予醋酸泼尼松片联合CsA治疗。比较两组患者治疗前、治疗1个月、3个月、6个月后的中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾小球滤过率(eGFR),外周血T淋巴细胞亚群(CD3+、CD4+/CD8+),血清肌酐、胆固醇、PLA2R,尿蛋白定量及血清蛋白水平变化,比较两组患者治疗6个月后的临床疗效及药品不良反应发生情况。结果:两组患者在治疗1个月、3个月或6个月后NGAL,CD3+、CD4+/CD8+,血清肌酐、胆固醇、PLA2R水平,尿蛋白定量水平均较治疗前明显降低,eGFR、血清白蛋白水平则较前明显升高(P<0.05);且观察组患者治疗1个月、3个月、6个月后NGAL、eGFR、外周血T淋巴细胞亚群水平、血清肌酐、PLA2R、尿蛋白定量和血清白蛋白水平均优于对照组(P<0.05),临床总有效率及药品不良反应发生率也优于对照组(P<0.05)。结论:CsA联合激素治疗PLA2R阳性MN患者疗效显著优于环磷酰胺联合激素,安全性高,且长期使用可改善患者外周血T淋巴细胞亚群水平。Objective:To observe the effect of cyclosporine(CsA)combined with small dose of glucocorticoid on M-type phospholipase A2 receptor(PLA2R)-positive membranous nephropathy(MN)and the effect on T lymphocyte subsets of patients.Methods:Totally 100 outpatients with serum PLA2R antibody positive MN were divided into the control group(50 cases)and the observation group(50 cases)by using random number table method.The control group was treated with prednisolone acetate tablets combined with cyclophosphamide(CTX),while the observation group was treated with prednisolone acetate tablets combined with CsA.The changes of neutrophil gelatinase-related lipid delivery protein(NGAL),glomerular filtration rate(eGFR),peripheral blood T lymphocyte subsets(CD3+,CD4+/CD8+),serum creatinine,cholesterol,serum PLA2R,urinary protein quantification and serum protein levels were detected in the two groups before the treatment and 1 month,3 months and 6 months after the treatment,and the clinical efficacy and incidence of adverse drug reactions of the two groups after 6-month treatment were compared as well.Results:Compared with those before the treatment,the levels of NGAL,CD3+,CD4+/CD8+,serum creatinine,cholesterol,PLA2 R and urinary protein were decreased,eGFR and serum albumin were increased in the two groups after 1-,3-and 6-month treatment(P<0.05).The improvement effects of NGAL,eGFR and T lymphocyte subsets in peripheral blood,serum creatinine,PLA2R,urinary protein and serum albumin levels in the observation group were all better than those in the control group after 1-,3-and 6-month treatment(P<0.05).The total clinical effective rate and the incidence of adverse drug reactions were also better than those in the control group(P<0.05).Conclusion:CsA combined with hormone is more effective than cyclophosphamide combined with hormone in the treatment of PLA2R positive MN patients,and the level of peripheral blood T lymphocyte subsets can be improved after long-term use with high safety.

关 键 词：环孢素 醋酸泼尼松 抗M型磷脂酶A2受体 膜性肾病 环磷酰胺 临床疗效 外周血T淋巴细胞亚群 

分 类 号：R979.5[医药卫生—药品]