双重血浆置换联合甲泼尼龙、霉酚酸酯双冲击疗法对重症紫癜性肾炎患儿免疫功能和肾功能的影响  

The effect of double plasma exchange combined with methylprednisolone and mycophenolate mofetil on immune function and renal function in children with severe purpura nephritis

作　　者：孙立宁[1] 曾聪灵 郭修枢 钟剑[1] 陈国华[1] Sun Lining;Zeng Congling;Guo Xiushu;Zhong Jian;Chen Guohua(Department of Pediatrics, Huizhou First People's Hospital, Guangdong Province, Huizhou 516000,China)

机构地区：[1]广东省惠州市第一人民医院儿科,516000

出　　处：《疑难病杂志》2020年第7期700-704,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：广东省医学科研基金立项项目(A20183269);广东省惠州市科技计划项目(20190403)。

摘　　要：目的观察双重血浆置换联合甲泼尼龙、霉酚酸酯双重冲击疗法对重症紫癜性肾炎患儿免疫功能及肾功能的影响。方法选择2015年1月—2018年12月广东省惠州市第一人民医院儿科诊治重症紫癜性肾炎患儿84例作为研究对象,按随机数字表法分为2组,每组42例。2组均进行常规治疗,对照组在此基础上给予甲泼尼龙联合霉酚酸酯双重冲击疗法治疗,研究组在对照组基础上联合双重血浆置换治疗。观察2组临床疗效、不良反应及治疗前后的免疫学指标和肾功能指标变化。结果研究组总有效率为95.24%,高于对照组的80.95%(χ^2/P=4.086/0.043)。治疗后2组患儿血清IgA、IgM、IgG、C3、C4、血肌酐(SCr)、血尿素氮(BUN)、24h尿蛋白定量、尿白蛋白(Alb)、尿β2-微球蛋白(β2-MG)均较治疗前降低,且研究组低于对照组(t/P=4.299/0.000,3.802/0.000,5.364/0.000,4.653/0.000,16.177/0.000,9.536/0.000,4.981/0.000,5.590/0.000,6.913/0.000,9.427/0.000)。2组胃肠道反应、血压升高、肝功能损害、白细胞减少、反复呼吸道感染发生率比较差异无统计学意义(P均>0.05)。结论双重血浆置换联合甲泼尼龙、霉酚酸酯双重冲击疗法可以有效降低重症紫癜性肾炎患儿血清IgA、IgM、IgG、C3、C4水平,纠正患儿机体的免疫紊乱,促进患儿肾功能恢复,且安全性良好。Objective To observe the effect of double plasma exchange combined with methylprednisolone and mycophenolate mofetil on immune function and renal function in children with severe purpura nephritis.Methods From January 2015 to December 2018,84 children with severe Henoch Schonlein purpura nephritis were selected as the study object.According to the random number table,the patients were divided into two groups,42 cases in each group.The control group was treated with methylprednisolone combined with mycophenolate mofetil.The study group was treated with double plasmapheresis on the basis of the control group.The clinical effect,adverse reactions,immunological indexes and renal function indexes before and after treatment were observed.Results The total effective rate in the study group was 95.24%,which was higher than that in the control group,80.95%(χ^2/P=4.086/0.043).After treatment,serum IgA,IgM,IgG,C3,C4,blood creatinine(SCr),blood urea nitrogen(BUN),24h urine protein quantification,urine albumin(Alb),urineβ2 microglobulin(β2-MG)Both were lower than before treatment,and the study group was lower than the control group(t/P=4.299/0.000,3.802/0.000,5.364/0.000,4.653/0.000,16.177/0.000,9.536/0.000,4.981/0.000,5.590/0.000,6.913/0.000,9.427/0.000).There was no significant difference in the incidence of gastrointestinal reactions,increased blood pressure,liver function impairment,leukopenia,and repeated respiratory infections between the two groups(all P>0.05).Conclusion Double plasma exchange combined with methylprednisolone and mycophenolate mofetil can effectively reduce the serum IgA,IgM,IgG,C3,C4 levels in children with severe Henoch Schonlein nephritis,correct the immune disorders of children,promote the recovery of children's renal function,and have good safety.

关 键 词：双重血浆置换 双重冲击疗法 重症紫癜性肾炎 免疫功能 肾功能 

分 类 号：R72[医药卫生—儿科]