强的松联合环磷酰胺冲击治疗难治性肾病综合征的临床观察  

Clinical Observation of Prednisone Combined with Cyclophosphamide in the Treatment of Refractory Nephrotic Syndrome

作　　者：姜楠 JIANG Nan(Department of Nephrology,Dandong First Hospital,Dandong 118000,China)

机构地区：[1]丹东市第一医院肾内科,辽宁丹东118000

出　　处：《中国医药指南》2022年第36期76-78,共3页Guide of China Medicine

摘　　要：目的 探讨强的松联合环磷酰胺冲击治疗难治性肾病综合征的临床疗效。方法 将142例难治性肾病综合征患者随机分为两组各71例,对照组采用强的松联合雷公藤多苷片治疗,研究组采用强的松联合环磷酰胺冲击治疗。经医院伦理委员会审核批准,患者知情同意治疗。比较两组难治性肾病综合征患者治疗后的T细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))以及白细胞介素-2(interleukin-2,IL-2)、白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、小鼠γ干扰素(mouse interferon-γ,IFN-γ),评价临床疗效。结果 研究组患者的CD_(3)^(+)为(60.73±5.38)%、CD_(4)^(+)为(40.11±6.59)%CD_(4)^(+)/CD_(8)^(+)为(1.54±0.83)%,明显高于对照组患者的(55.27±6.72)%、(37.80±7.12)%、(1.27±0.68)%,CD_(8)^(+)明显低于对照组[(26.31±3.70)%vs.(29.73±4.55)%],组间数据比较有明显差异(P <0.05)。治疗后,研究组患者的IL-2为(184.83±17.48)ng/L、IL-8为(53.85±13.20)ng/L、TNF-α为(65.72±15.39)ng/L、IFN-γ为(246.29±63.83)ng/L,明显低于对照组患者的(213.21±16.42)ng/L、(75.73±16.03)ng/L、(79.04±14.92)ng/L、(337.16±93.18)ng/L,组间数据比较有明显差异(P <0.05)。研究组患者中,完全缓解27例(38.02%),显著缓解17例(23.94%),部分缓解23例(32.40%),无效4例(5.64%);对照组患者中,完全缓解13例(18.30%),显著缓解21例(29.58%),部分缓解25例(35.21%),无效12例(16.91%)。研究组总有效率明显高于对照组(94.37%vs.83.10%)(P <0.05)。结论 与强的松联合雷公藤多苷片治疗比较,强的松联合环磷酰胺冲击对难治性肾病综合征的临床疗效较好,且能够有效调节患者的机体免疫功能,减轻肾病炎性反应。Objective To investigate the clinical efficacy of prednisone combined with cyclophosphamide in the treatment of refractory nephrotic syndrome.Methods One hundred and forty-two patients with refractory nephrotic syndrome were randomly divided into two groups with 71 cases in each group.The control group was treated with prednisone combined with tripterygium polyglycosides,and the study group was treated with prednisone combined with cyclophosphamide pulse therapy.After review and approval by the hospital ethics committee,the patient informed consent for treatment.To compare the T cell subsets(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)) and interleukin-2(IL-2),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),mouse interferon-γ(IFN-γ),to evaluate the clinical efficacy.Results CD_(3)^(+) in the study group is(60.73±5.38)%,CD_(4)^(+) is(40.11±6.59)%,CD_(4)^(+)/CD_(8)^(+) is(1.54±0.83)%,which was significantly higher than that of(55.27±6.72)%,(37.80±7.12)%,(1.27±0.68)% in the control group,CD_(8)^(+) was significantly lower than the control group [(26.31±3.70)% vs.(29.73±4.55)%],there are significant differences in the data between the groups(P<0.05).The IL-2 of the study group is(184.83±17.48) ng/L,IL-8 is(53.85±13.20) ng/L,TNF-α is(65.72±15.39) ng/L,IFN-γis(246.29±63.83) ng/L,which was significantly higher than that of(213.21±16.42) ng/L,(75.73±16.03) ng/L,(79.04±14.92) ng/L,(337.16±93.18) ng/L in the controp group,there are significant differences in the data comparison between the groups(P<0.05).Among the patients in the study group,27 cases(38.02%) had complete remission,17 cases had significant remission(23.94%),and 23 cases had partial remission(32.40%),which were invalid 4 cases(5.64%);in the control group,13 cases(18.30%) had complete remission,21 cases had significant remission(29.58%),25 cases had partial remission(35.21%),and 12 cases had no effect(16.91%).The total effective rate of the study group was significantly higher than that of the control group(94.37% vs.83.10%)

关 键 词：强的松 环磷酰胺冲击 难治性肾病综合征 炎性水平 免疫功能 治疗效果 

分 类 号：R692[医药卫生—泌尿科学]