吗替麦考酚酯联合泼尼松治疗儿童狼疮性肾炎的临床疗效研究  

Clinical efficacy of mycophenolate mofetil combined with prednisone in the treatment of children with lupus nephritis

作　　者：张翼[1] 李志辉[1] 丁云峰[1] 寻劢[1] 段翠蓉[1] 吴天慧[1] Zhang Yi;Li Zhihui;Ding yunfeng;Xun Mai;Duan Cuirong;Wu Tianhui(Department of Nephrology and Rheumatism,Hunan Children's Hospital,Changsha 410008,China)

机构地区：[1]湖南省儿童医院肾脏风湿科,长沙410008

出　　处：《国际免疫学杂志》2023年第2期151-157,共7页International Journal of Immunology

基　　金：湖南省卫生健康委科研课题(202206013964)

摘　　要：目的探究吗替麦考酚酯联合泼尼松治疗儿童狼疮性肾炎的临床疗效及安全性。方法选取湖南省儿童医院2019年1月至2021年6月收治的86例儿童狼疮性肾炎患儿作为研究对象,采用随机数字表法分为研究组和对照组,每组43例,对照组予以环磷酰胺+泼尼松治疗,研究组予以吗替麦考酚酯+泼尼松治疗,评估两组患儿治疗6个月后临床疗效;检测并比较两组研究对象血肌酐(serum creatinine,Scr)、血浆白蛋白(albumin,Alb)、24 h蛋白尿定量、肾小球滤过率(glomerular filtration rate,GFR)、免疫球蛋白(immunoglobulin,Ig)A、IgG、IgM水平,比较两组狼疮活动度评分及肾组织活动指数评分,并记录两组患儿给药期间不良反应发生情况。结果研究组临床疗效优于对照组,差异有统计学意义(93.02%比72.09%,χ^(2)=6.54,P<0.05)。研究组治疗后24 h蛋白尿、Scr水平均低于对照组[g/24 h:(0.56±0.17)比(1.01±0.23),mmol/L:(81.45±7.69)比(97.82±8.16),t值分别为10.32,9.57,P值均<0.05],Alb、GFR水平均高于对照组[g/L:(44.81±5.33)比(36.79±4.02),mL/min:(114.05±8.31)比(89.76±10.25),t值分别为7.88,12.07,P值均<0.05]。研究组治疗后肾组织活动指数评分低于对照组[分:(3.64±0.79)比(4.21±0.83),t=3.26,P<0.05]。研究组治疗后IgA、IgG水平均低于对照组[g/L:(1.19±0.22)比(1.65±0.24),g/L:(7.94±2.67)比(9.16±1.15),t值分别为9.27,2.75,P值均<0.05],IgM水平高于对照组[g/L:(1.29±0.28)比(0.92±0.26),t=6.35,P<0.05]。研究组治疗期间总不良反应发生率低于对照组(11.63%比30.23%,χ^(2)=4.50,P<0.05)。结论吗替麦考酚酯联合泼尼松治疗儿童狼疮性肾炎可有效提高其临床疗效,调节肾功能相关血尿生化指标水平,稳定免疫功能且安全性良好。Objective To explore the clinical efficacy and safety of mycophenolate mofetil combined with prednisone in the treatment of children with lupus nephritis.Methods Eighty-six children with lupus nephritis admitted to Hunan Provincial Children's Hospital from January 2019 to June 2021 were selected as the study objects,and were randomly divided into the study group and the control group,with 43 cases in each group,and the control group was given cyclophosphamide.Combined with prednisone therapy,the research group was given mycophenolate mofetil combined with prednisone therapy.The clinical efficacy of the two groups after 6 months of treatment was evaluated.Serum creatinine(Scr),plasma albumin(Alb),24 h proteinuria,glomerular filtration rate(GFR),and immunoglobulin(Ig)A,IgG,IgM and other renal function-related hematuria biochemical or immune index levels,compared the lupus activity score and renal tissue activity index score between the two groups,and recorded the occurrence of adverse reactions in the two groups during administration.Results The clinical efficacy of the study group was better than that of the control group,with a statistically significant difference(93.02%vs 72.09%,χ^(2)=6.54,P<0.05).The levels of proteinuria and Scr in the study group at 24 hours after treatment were lower than those in the control group[g/24 h:(0.56±0.17)vs(1.01±0.23),mmol/L:(81.45±7.69)vs(97.82±8.16),t values were 10.32 and 9.57 respectively,both P values<0.05],and the levels of Alb and GFR were higher than those in the control group[g/L:(44.81±5.33)vs(36.79±4.02),mL/min:(114.05±8.31)vs(89.76±10.25),t values were 7.88 and 12.07 respectively,both P values<0.05].After treatment,the score of renal tissue activity index in the study group was lower than that in the control group[score:(3.64±0.79)vs(4.21±0.83),t=3.26,P<0.05].After treatment,the levels of IgA and IgG in the study group were lower than those in the control group[g/L:(1.19±0.22)vs(1.65±0.24),g/L:(7.94±2.67)vs(9.16±1.15),t values were 9.27 and 2.75 respect

关 键 词：狼疮性肾炎 吗替麦考酚酯 泼尼松治疗 免疫功能 安全性 儿童 

分 类 号：R725.9[医药卫生—儿科]