他克莫司联合激素对儿童激素耐药难治性肾病综合征的疗效研究

Curative Effect of Tacrolimus Combined with Steroid in Children with Steroid-Resistant Intractable Nephrotic Syndrome

目的:观察他克莫司联合激素对激素耐药难治性肾病综合征患儿调节性T细胞(Treg)的影响及其临床疗效。方法:选取2012年8月至2014年12月余姚市第二人民医院儿科常规激素治疗无效的肾病综合征患儿40例,另选取我院保健中心体检的健康儿童40例作为正常对照。使用流式细胞仪检测Treg,比较两组治疗前后24 h尿蛋白定量、血肌酐、血清白蛋白、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、胆固醇、甘油三酯等临床指标的变化。结果:健康儿童、肾病综合征患儿治疗前和治疗后Treg在外周血的比例分别为7.12%±1.64%、1.84%±0.51%、6.08%±1.23%,差异有统计学意义(P<0.05)。他克莫司治疗后患儿24 h尿蛋白定量从(113.2±24.3)mg/kg减少至(24.2±3.6)mg/kg(P<0.01),血清白蛋白水平从(19.2±2.5)g/L升高至(34.8±4.7)g/L(P<0.01);血肌酐治疗前后比较差异无统计学意义(P>0.05)。他克莫司治疗后患儿胆固醇和甘油三酯水平分别从(12.1±2.3)mmol/L和(5.9±1.2)mmol/L下降至(4.3±1.1)mmol/L和(2.8±0.6)mmol/L,差异均有统计学意义(P<0.01)。他克莫司治疗前后患儿丙氨酸氨基转移酶和天门冬氨酸氨基转移酶水平比较差异无统计学意义(P>0.05)。40例激素耐药难治性肾病患儿经他克莫司治疗后临床缓解率为82.5%,不良反应发生率为12.5%。结论:他克莫司可以显著升高激素耐药肾病患儿Treg的比例,调节患儿的免疫失衡,对激素耐药肾病患儿具有显著临床疗效,使用安全,有一定的临床推广使用价值。

Objective： To observe the effect of tacrolimus combined with steroid on Treg cells in children with steroid-resistant intractable nephrotic syndrome（ SRNS）,and explore its clinical efficacy. Methods： A total of 40 children with SRNS were enrolled in this study. Another 40 cases of healthy children were used as normal control. The Treg cells were detected by flow cytometer. The 24 h urinary protein,Scr,Alb,ALT,AST,TC,TG of two groups were compared before and after treatment. Results： The percents of Treg cells in healthy children,SRNS children（ before treatment）,and SRNS children（ after treatment） were 7. 12% ± 1. 64%,1. 84% ±0. 51%,and 6.08% ±1.23%,there were significant differences among them（ P〈0.05）. After treatment,24 h urinary protein of children with SRNS was decreased from（ 113.2±24.3） mg / kg to（ 24.2± 3.6） mg / kg（ P 〈 0.01）,Alb was increased from（ 19.2± 2. 5） g / L to（ 34.8±4. 7） g/L（ P〈0.01）. However,there was no significant change of Scr before and after treatment（ P〉0.05）. After treatment,TC and TG were decreased from（ 12.1±2.3） mmol / L and（ 5.9±1.2） mmol / L to（ 4.3±1.1） mmol / L and（ 2.8±0. 6） mmol / L（ P〈0.01）. There were no significant changes of ALT and AST before and after treatment（ P〉0.05）.The clinical remission rate was 82. 5%,with a clinical adverse reaction rate of 12.5%. Conclusion： Tacrolimus can increase the percentage of Treg cells in children with SRNS,which can regulate immune disorder and be conductive to treat SRNS children. It is worthy of clinical application.