胸腺肽α_1联合糖皮质激素冲击治疗难治性肾病综合征

Clinical research of thymosin α_1 combined with glucocorticosteroid pulse therapy in treatment of adult refractory nephrotic syndrome

目的研究胸腺肽α1在大剂量糖皮质激素冲击治疗成人难治性肾病综合征(refractory nephrotic syndrome,RNS)过程中对肾病转归的影响及其对治疗过程中并发感染的防治作用。方法入选45例临床确诊的RNS病人,分为观察组24例与对照组21例,2组基线资料均衡。观察组给予甲泼尼龙琥珀酸钠(MP)冲击联合胸腺肽α1治疗,MP冲击治疗1～3个疗程,如有效则渐转为维持量,3个疗程无效则放弃该疗法;胸腺肽α1疗程3个月。对照组仅MP冲击治疗1～3个疗程。比较2组病人治疗前后24h尿蛋白定量、血浆白蛋白、胆固醇3项指标的变化及治疗的总有效率、完全缓解率、显著缓解率、部分缓解率及感染率。观察期6个月。结果治疗后2组病人24h尿蛋白定量、血浆白蛋白、胆固醇3项指标较治疗前均有改善(P均<0.01),且观察组治疗后3项指标明显优于对照组(P均<0.01)。观察组显著缓解率高于对照组(P<0.05);完全缓解率、部分缓解率、总有效率与对照组比较差异均无统计学意义(P均>0.05);感染发生率明显低于对照组(P<0.05)。结论胸腺肽α1能够增加机体抗感染能力,增强对激素冲击治疗的耐受力,双向调节RNS患者的免疫失衡,有效提高激素冲击治疗RNS的显著缓解率。

Objective To research the impact of thymosin α1 on prognosis and its implications for treatment,and prevention of concurrent infection during the course of high-dose glucocorticosteroid treatment of adult refractory nephrotic syndrome（RNS）.Methods A total of 45 patients with clinically confirmed RNS were enrolled in this study and divided into observation group （n=24） and control group （n=21）.The basic data （age,sex,pathological classification,24-hour urinary protein,plasma albumin and cholesterol） of two groups had no significant difference （all P〉0.05）.The methylprednisolone sodium succinate （MP） pulse therapy combined with thymosin α1 was taken in observation group, while only MP pulse therapy was taken in control group.MP was administered for 1-3 courses. If MP pulse therapy was effective,maintaining dose was succeeded,if invaild,the remedy was terminated.Thymosin α1was administered for 3 months. The 24-hour urinary protein,plasma albumin and cholesterol before and after treatment were compared in two groups,and clinical therapeutic effects including total effective rate, complete remission rate,significant remission rate, partial remission rate and infection rate were compared in two groups too.The period of observation was 6 months.Results Compared with before treatment,the levels of 24-hour urinary protein and plasma cholesterol obviously decreased（all P〈0.01）, and the levels of plasma albumin increased significantly （all P〈0.01） after treatment in two groups.Compared with control group,the aforementioned indexes improved obviously in observation group （all P〈0.01）.The significant remission rate of observation group was higher than that of control group （62.5% vs 28.6%,P〈0.05）,while total effective rate （95.8% vs 81.0%）and complete remission rate （16.7% vs 14.3%） remained no difference （all P〉0.05）.The infection rates of 1-3 months and 4-6months in observation group were all significantly lower than those in control group（12.5% vs 42.9%,P〈0.05;4.2% vs 42.9%,P〈0.01）. Conclusions Thymosin α1 can increase the body＇s anti-infective capabilities, enhance the tolerance on the glucocorticosteroid pulse therapy, bi-directionally regulate immune imbalance of RNS patients and notably raise the significant remission rate of RNS treatment.