甲泼尼龙冲击治疗儿童紫癜性肾炎伴少量新月体病变的单中心回顾性研究  

Efficacy and safety of methylprednisolone pulse for Henoch-Schoenlein purpura nephritis with few crescentic lesions

作　　者：刘慧丹 宋丹 宋纯东[2] 张博[2] 郭婷[2] 杨濛[2] 张霞[2] 任献青[1] Liu Hui-dan;Song dan;Song Chun-dong;Zhang Bo;Guo Ting;Yang Meng;Zhang Xia;Ren Xian-qing(Henan University of Traditional Chinese Medicine,Zhengzhou 450046,China;Department of Pediatrics,First Affiliated Hospital,Henan University of Traditional Chinese Medicine,Zhengzhou 477150,China)

机构地区：[1]河南中医药大学,郑州450046 [2]河南中医药大学第一附属医院儿科,郑州477150

出　　处：《临床肾脏病杂志》2023年第8期628-634,共7页Journal Of Clinical Nephrology

基　　金：国家自然基金(82074493);河南省中医药学科领军人才项目[豫卫中医函(2021)8号];河南省中医管理局国家中医临床研究基地科研专项重点课题(2018JDZX119);河南省中医药管理局国家中医临床研究基地科研专项普通项目(2018JDZX017)。

摘　　要：目的探讨甲泼尼龙(methylprednisolone,MP)冲击治疗在过敏性紫癜性肾炎(henoch-schoenlein purpura nephritis,HSPN)伴少量新月体病变患儿中的临床疗效与安全性,以期为HSPN伴肾脏少量新月体病变患儿的治疗提供临床依据。方法用回顾性分析方法,收集自2015年1月至2021年6月于河南中医药大学第一附属医院儿科肾病区住院,行肾活检确诊为HSPN且肾脏新月体比例在10%~20%并符合纳入标准的142例患儿为研究对象。根据用药情况分为MP组70例和非MP组72例。观察2组患儿在临床疗效、药物不良反应及预后方面的差异。结果2组患儿治疗前后24 h尿蛋白定量(24 hour urinary total protein,24 hUTP)、尿红细胞计数均较治疗前显著下降(P<0.05),血清白蛋白治疗3、6个月时较治疗前明显上升(P<0.05),血肌酐保持稳定,2组组间比较差异无统计学意义(P>0.05),MP组治疗6个月时24 hUTP低于前一时间点(P<0.05),非MP组治疗6个月时24 hUTP与前一时间点比较差异无统计学意义(P>0.05);2组组间在不同时间点的完全缓解率及总有效率差异无统计学意义(P>0.05);2组患儿预后等级差异无统计学意义(P>0.05),MP组尿检异常时间、糖皮质激素服用疗程均短于非MP组(P<0.05),MP组复发率低于非MP组;MP组不良反应发生率高于非MP组(P<0.05)。结论MP冲击治疗HSPN伴10%~20%新月体病变患儿短期疗效与口服糖皮质激素相当,但降低尿蛋白的效果更稳定持久,可有效缩短患儿尿检异常时间及糖皮质激素服用疗程,降低复发率,但是MP冲击疗法更容易出现不良反应。Objective To explore the clinical efficacy and safety of methylprednisolone(MP)pulse in children with Henoch-Schoenlein purpura nephritis(HSPN)with few crescentic lesions to provide therapeutic rationales.Methods A retrospective review was conducted for 142 children hospitalized from January 2015 to June 2021.HSPN was confirmed by renal biopsy and had a renal crescent proportion of 10%-20%.Inter-group differences in clinical efficacy,adverse drug reactions and prognosis were recorded.Results 24 h hourly urine protein quantification(24 hUTP)and urine red blood cell count of children in 2 groups post-treatment were significantly lower than pre-treatment(P<0.05).Serum albumin(Alb)rose markedly after 3/6-month treatment as compared with pre-treatment(P<0.05).Serum creatinine(Scr)stabilized and inter-group difference was not statistically significant(P>0.05).24 hUTP in MP group at Month 6 was lower than the previous timepoint(P<0.05).24 hUTP at 6 months of treatment was lower than the previous timepoint in MP group(P<0.05)and 24 hUTP at 6 months of treatment in non-MP group was not statistically significant compared with the previous timepoint(P>0.05);Inter-group differences in complete remission rate and total effective rate at different timepoints were not statistically significant(P>0.05);Inter-group differences in prognostic grade were not statistically significant(P>0.05)and time of abnormal urinalysis was shorter in MP group than that in non-MP group(P>0.05).Time of abnormal urinalysis was shorter in MP group than that in non-MP group(P<0.05),duration of glucocorticoid dosing was shorter in MP group than that in non-MP group(P<0.05)and recurrence rate was lower in MP group than that in non-MP group;the incidence of adverse reactions was higher in MP group than that in non-MP group(P<0.05).Conclusions In HSPN children with 10%-20%crescentic lesions,short-term efficacy of MP shock therapy is comparable to that of oral glucocorticoids.However,the effect of reducing urinary protein is more stable and long-lasting an

关 键 词：甲泼尼龙 儿童 过敏性紫癜性肾炎 新月体 药物疗法 预后 不良反应 

分 类 号：R726.9[医药卫生—儿科]