环孢素A联合甲泼尼龙冲击治疗重症紫癜性肾炎患儿的疗效及对蛋白尿、VCAM-1和VEGF的影响  

The efficacy of cyclosporine A combined with methylprednisolone in the treatment of children with severe purpuric nephritis and its effect on proteinuria,VCAM-1 and VEGF

作　　者：白玲 马兰红 麦迪娜 珠帕尔 陆晨 BAI Ling;MA Lanhong;MAI Dina;ZHU Paer;LU Chen(Department of Pediatrics, The People′s Hospital of Xinjiang Autonomous Region, Urumqi 830011, China)

机构地区：[1]新疆自治区人民医院儿科,新疆乌鲁木齐830011

出　　处：《西部医学》2021年第5期693-696,700,共5页Medical Journal of West China

基　　金：新疆维吾尔自治区自然科学基金(2018D01C123)。

摘　　要：目的探讨环孢素A联合甲泼尼龙冲击治疗重症紫癜性肾炎患儿的疗效及对蛋白尿、血清可溶性血管细胞粘附分子-1(sVCAM-1)、血管内皮生长因子(VEGF)的影响。方法选择2015年3月~2018年4月我院收治的86例重症紫癜性肾炎患儿者为研究对象,按随机数表法分为观察组和对照组,每组各43例。对照组给予甲泼尼龙治疗,观察组在对照组的基础上联合环孢素A治疗,两组均连续治疗6个月。比较两组临床疗效、治疗前后炎症因子、免疫球蛋白、尿蛋白、血清VCAM-1和VEGF的变化情况及不良反应。结果治疗后,观察组临床疗效总有效率为95.35%,明显高于对照组的81.40%(P<0.05);观察组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平均低于对照组(P<0.05);观察组免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)的指标水平均明显高于对照组(P<0.05);观察组微量白蛋白尿(MAU)、24h尿蛋白定量、血尿β2微球蛋白(β2-MG)的指标水平均低于对照组(P<0.05);观察组VCAM-1、VEGF均低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论环孢素A联合甲泼尼龙冲击治疗重症紫癜性肾炎患儿的临床疗效突出,可降低尿蛋白的指标水平,能有效改善VCAM-1、VEGF的表达。Objective To study the effect of cyclosporine a combined with methylprednisolone on severe Henoch Schonlein purpura nephritis and on proteinuria,serum soluble vascular cell adhesion molecule-1(sVCAM-1),vascular endothelial growth factor(VEGF).Methods From March 2015 to April 2018,86 children with severe Henoch Schonlein purpura nephritis in our hospital were selected for study.They were divided into observation group and control group by random number table method,43 cases in each group.The control group was treated with methylprednisolone.The observation group was treated with cyclosporine A on the basis of the control group.Both groups were treated for 6 months continuously.The clinical effect,changes of inflammatory factors,immunoglobulin,urinary protein,serum VCAM-1 and VEGF before and after treatment and adverse reactions were compared between the two groups.Results The total effective rate of clinical efficacy in the observation group was 95.35%,which was significantly higher than the control group's 81.40%(P<0.05).The levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in observation group were lower than those in control(P<0.05).The levels of IgA,IgG and IgM in the observation group were significantly higher than those in the control group(P<0.05).The levels of microalbuminuria(MAU),24h urine protein,and hematuriaβ2-MG in the observation group were lower than those in the control group(P<0.05).The levels of serum soluble vascular cell adhesion molecule-1(sVCAM-1)and vascular endothelial growth factor(VEGF)in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Cyclosporine A combined with methylprednisolone has a prominent clinical effect on children with severe purpuric nephritis,can reduce the level of urine protein,and can effectively reduce the expression of VCAM-1 and VEGF.

关 键 词：重症紫癜性肾炎 环孢素A 甲泼尼龙 蛋白尿 可溶性血管细胞粘附分子-1 血管内皮生长因子 

分 类 号：R692.34[医药卫生—泌尿科学]