他克莫司联合糖皮质激素治疗过敏性紫癜性肾炎患儿的效果及对免疫功能、血清sICAM-1的影响  

Clinical Efficacy of Tacrolimus Combined with Glucocorticoid in Treatment of Children with Henoch Schonlein Purpura Nephritis and Their Effects on Immune Function and Serum s ICAM-1

作　　者：张芳 李海英[2] ZHANG Fang;LI Hai-ying(Department of Dermatology and Venereology,the Second People's Hospital of Binzhou City,Binzhou,Shandong 256800,China;Department of Dermatology and Venereal Diseases,Affiliated Hospital of Binzhou Medical College,Binzhou,Shandong 256699,China)

机构地区：[1]滨州市第二人民医院皮肤性病科,山东滨州256800 [2]滨州医学院附属医院皮肤性病科,山东滨州256699

出　　处：《临床误诊误治》2022年第5期19-22,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2021年度山东省自然科学基金项目(2021SD0895)。

摘　　要：目的探讨他克莫司联合糖皮质激素治疗对过敏性紫癜性肾炎(HSPN)患儿的疗效、免疫功能及血清可溶性细胞间黏附分子-1(sICAM-1)的影响。方法选取2020年2月—2021年4月收治的HSPN患儿84例,据治疗方法分为观察组和对照组各42例。2组均予基础治疗,观察组予他克莫司联合醋酸泼尼松片治疗,对照组予环磷酰胺联合醋酸泼尼松片治疗。比较2组临床疗效、治疗前后肾功能指标、免疫功能指标及血清sICAM-1水平,并记录不良反应发生情况。结果观察组总有效率高于对照组(P<0.05)。2组治疗后24 h尿蛋白定量、尿β_(2)-微球蛋白、血肌酐、尿素和血清sICAM-1水平均较治疗前降低,且观察组低于对照组(P<0.01)。2组治疗后CD4+、CD8+及CD4+/CD8+均较治疗前改善,且观察组改善程度优于对照组(P<0.05,P<0.01)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论他克莫司联合醋酸泼尼松片治疗HSPN患儿效果显著,能明显改善患儿肾功能,抑制机体免疫反应,降低血清sICAM-1水平,且安全性较高。Objective To investigate clinical efficacy of Tacrolimus combined with Glucocorticoid in treatment of children with Henoch Schonlein purpura nephritis(HSPN) and their effects on immune function and serum soluble intercellular adhesion molecule-1(sICAM-1). Methods A total of 84 children with HSPN admitted between February 2020 and April 2021 were selected and divided into observation group(n=42) and control group(n=42) according to therapeutic methods. Both groups were given basic treatments, and then observation group was treated with Tacrolimus combined with Prednisone Acetate Tablets, while control group was treated with Cyclophosphamide combined with Prednisone Acetate Tablets. Clinical efficacy, renal function indexes, immune function indexes and serum levels of sICAM-1 before and after treatment were compared between two groups, and incidence rates of adverse reactions were recorded. Results The total effective rate in observation group was significantly higher than that in control group(P<0.05). After treatment, levels of 24-h urine protein quantification, urine β_(2)-microglobulin, serum creatinine, urea and serum sICAM-1 were significantly lower than those before treatment in two groups, and the levels in observation group were significantly lower than those in control group(P<0.01). After treatment, levels of CD4+, CD8+ and CD4+/CD8+ were significantly improved compared with those before treatment in two groups, and the improved conditions in observation group were better than those in control group(P<0.05, P<0.01). There was no significant difference in the total incidence rate of adverse reactions between two groups(P>0.05). Conclusion Tacrolimus combined with Prednisone Acetate Tablets is effective in treatment of children with HSPN. It may significantly improve renal function, inhibit immune reaction and reduce level of serum sICAM-1 with good safety.

关 键 词：紫癜 过敏性 肾炎 他克莫司 24 h尿蛋白定量 可溶性细胞间黏附分子1 儿童 

分 类 号：R726.929[医药卫生—儿科]