环磷酰胺联合利妥昔单抗治疗儿童难治性肾病综合征的效果观察  

Observation on the effect of Cyclophosphamide combined with Rituximab in the treatment of refractory nephrotic syndrome in children

作　　者：夏伟 XIA Wei(Department of Pediatric Nephrology,BenQ Medical Center,the Affiliated BenQ Hospital of Nanjing Medical University,Jiangsu Province,Nanjing 210000,China)

机构地区：[1]南京明基医院南京医科大学附属明基医院儿肾科,江苏南京210000

出　　处：《中国当代医药》2023年第21期71-75,共5页China Modern Medicine

摘　　要：目的探讨环磷酰胺联合利妥昔单抗治疗儿童难治性肾病综合征的临床效果。方法选取南京医科大学附属明基医院2019年7月至2021年7月接受治疗的98例儿童难治性肾病综合征患儿为研究对象,采取随机数字表法分为对照组(n=49)与联合组(n=49),对照组采用糖皮质激素+他克莫司+环磷酰胺治疗,联合组在对照组基础上给予利妥昔单抗治疗。治疗后评估两组患儿的临床疗效,比较两组患儿治疗前、治疗1个月后的肾功能及免疫功能,比较两组患儿的不良反应。结果联合组患儿治疗总有效率为95.92%,高于对照组的81.63%,差异有统计学意义(P<0.05);两组患儿治疗1个月后的血肌酐(SCr)、尿素氮(BUN)水平、尿蛋白定量及β2微球蛋白(β2-MC)水平均低于本组治疗前,差异有统计学意义(P<0.05);且联合组患儿治疗1个月后的SCr、BUN水平、尿蛋白定量及β2-MC水平均低于对照组,差异有统计学意义(P<0.05);两组患儿治疗1个月后的CD20+B水平均低于本组治疗前,差异有统计学意义(P<0.05),且联合组患儿治疗1个月后的CD20+B水平低于对照组,差异有统计学意义(P<0.05);两组患儿治疗过程中的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论临床采用环磷酰胺联合利妥昔单抗治疗儿童难治性肾病综合征可获得更好的临床疗效,能够有效改善患儿的肾功能水平和免疫功能水平,有助于患儿的预后,同时未明显增加不良反应,有临床借鉴价值。Objective To investigate the clinical effect of Cyclophosphamide combined with Rituximab in the treatment of refractory nephrotic syndrome in children.Methods A total of 98 children with refractory nephrotic syndrome who were treated in the Affiliated BenQ Hospital of Nanjing Medical University from July 2019 to July 2021 were selected as the research objects.They were divided into control group(n=49)and combination group(n=49)by random number table method.The control group was treated with glucocorticoid+Tacrolimus+Cyclophosphamide,while the combination group were treated with Rituximab on the basis of the control group.After treatment,the clinical efficacy of the two groups was evaluated,the renal function and immune function of the two groups were compared before treatment and 1 month after treatment,and the adverse reactions of the two groups were compared.Results The total effective rate of the combination group was 95.92%,which was higher than 81.63%of the control group,and the difference was statistically significant(P<0.05).After 1 month of treatment,the levels of serum creatinine(SCr),blood urea nitrogen(BUN),urinary protein andβ2-microglobulin(β2-MC)in the two groups were lower than those before treatment,and the differences were statistically significant(P<0.05).After 1 month of treatment,the levels of SCr,BUN,urine protein andβ2-MC in the combination group were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of CD20+B in the two groups after 1 month of treatment were lower than those before treatment,and the difference was statistically significant(P<0.05),and the level of CD20+B in the combination group after 1 month of treatment was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Clinical application of Cyclophosphamide combined with Rituximab in the treatment of children

关 键 词：环磷酰胺 利妥昔单抗 糖皮质激素 儿童难治性肾病综合征 肾功能 免疫功能 不良反应 

分 类 号：R726.9[医药卫生—儿科]