MMF联合CsA治疗成人激素抵抗MCNS的效果及对外周血NF-κB及AP-1水平的影响  

The effect of mycophenolate mofetil combined with cyclosporin A in the treatment of adult hormone-resistant minimal change nephrotic syndrome and the effectsonperipheral blood nuclear factor-κB and activated protein-1 levels

作　　者：钟杰 安春兰 张家丽[3] ZHONG Jie;AN Chun-lan;ZHANG Jia-li(Department of Nephrology,Affiliated Hospital of Panzhihua University,Panzhihua 617000,Sichuan,China;不详)

机构地区：[1]攀枝花学院附属医院肾内科,四川攀枝花617000 [2]绵阳市游仙区人民医院肾内科,四川绵阳621004 [3]自贡市第三人民医院肾内科,四川自贡643000

出　　处：《广东医学》2022年第10期1296-1300,共5页Guangdong Medical Journal

基　　金：攀枝花市市级指导性科技计划项目(2019-CY-S-11)。

摘　　要：目的观察霉酚酸酯(MMF)联合环孢素A(CsA)治疗成人激素抵抗微小病变型肾病综合征(MCNS)的临床疗效,及其对患者外周血核因子-κB(NF-κB)及活化蛋白(AP-1)水平的影响。方法选取2017年3月至2021年3月收治的300例激素抵抗性MCNS患者作为研究对象,以抽签法随机分为观察组(150例)及对照组(150例)。对照组采取泼尼松及CsA治疗,观察组在对照组基础上加用MMF治疗。比较两组患者生化指标(24 h尿蛋白定量、血清白蛋白、血糖、尿酸及血肌酐)、外周NF-κB、AP-1水平。统计两组患者临床疗效、不良反应发生情况及疾病复发率。结果两组治疗后24 h尿蛋白定量低于治疗前,血清白蛋白高于治疗前(P<0.05),且观察组24 h尿蛋白定量低于对照组,血清白蛋白高于对照组(P<0.05);治疗后两组外周血单个核细胞(PBMC)NF-κB及AP-1与DNA结合活性低于治疗前,且观察组低于对照组(P<0.05);两组临床疗效等级比较差异有统计学意义(Z=8.542,P=0.026),观察组临床总缓解率(90.00%)高于对照组(80.00%),差异有统计学意义(χ^(2)=4.660,P=0.031);观察组各项不良反应发生率及复发率与对照组比较差异无统计学意义(P>0.05)。结论应用MMF与CsA联合治疗成人激素抵抗MCNS患者,可改善患者肾功能,降低PBMC NF-κB及AP-1与DNA结合活性,疗效较好,且不增加不良反应发生风险及复发率。Objective To observe the clinical efficacy of mycophenolate mofetil(MMF)combined with cyclosporine A(CsA)in the treatment of adult hormone-resistant minimal change nephrotic syndrome(MCNS),and its effect on peripheral blood nuclear factorκB(NF-κB)and activated protein(AP-1).Methods A total of 300 patients with hormone-resistant MCNS who were admitted to the Affiliated Hospital of Panzhihua University from March 2017 to March 2021 were selected as the research subjects and randomly divided into the experimental group(150 cases)and the control group(150 cases)by lottery method.The control group was treated with prednisone and CsA,and the experimental group was treated with MMF on the basis of the control group.Biochemical indexes(24-hour urine protein quantification,serum albumin,blood glucose,uric acid and serum creatinine),peripheral NF-κB and AP-1 levels were compared between the two groups.The clinical efficacy,adverse reactions and disease recurrence rate of the two groups were compared.Results The 24-hour urine protein quantification after treatment was significantly lower than that before treatment,and the serum albumin was significantly higher than that before treatment(P<0.05);the 24-hour urine protein quantification in the experimental group was significantly lower than that in the control group,and the serum albumin was significantly higher than that in the control group(P<0.05).After treatment,the binding activities of NF-κB and AP-1 to DNA in peripheral blood of PBMC in the two groups were significantly lower than those before treatment,and the experimental group was lower than the control group(P<0.05).There was a statistically significant difference in the clinical efficacy grade between the two groups(Z=8.542,P=0.026),and the total clinical remission rate in the experimental group(90.00%)was significantly higher than that in the control group(80.00%,χ^(2)=4.660,P=0.031).There was no significant difference in the incidence of adverse reactions orrecurrence rates between the experimental group an

关 键 词：激素抵抗 微小病变 肾病综合征 霉酚酸酯 环孢素A 核因子-κB 活化蛋白-1 

分 类 号：R692[医药卫生—泌尿科学] R96[医药卫生—外科学]