霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的疗效观察

Observation on the Curative Effect of Mycophenolate Mofetil Combined with Glucocorticosteroid on the Children with Anaphylatic Purpura Nephritis

目的:探究霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的疗效及安全性。方法:选择2012年3月~2015年9月70例于我院就诊的紫癜性肾炎儿童,按照不同的治疗方法将其分为观察组(35例)和对照组(35例)。两组患者入院后均给予常规治疗,在此基础上观察组患者给予泼尼松联合霉酚酸酯治疗,对照组给予泼尼松联合环磷酰胺治疗。比较两组的总有效率、临床症状消失时间、生化指标、免疫功能及不良反应发生情况。结果:观察组的临床总有效率为94.29%(33/35),对照组的总有效率为85.17%(30/35),两组比较差异无统计学意义(P=0.232)。治疗后,观察组蛋白尿、血尿等临床症状消失时间与对照组比较差异无显著意义(P>0.05);两组患儿的24 h蛋白定量、CD19^+水平均较治疗前显著降低,且观察组CD19^+水平显著低于对照组(P<0.05),两组的血清白蛋白、总蛋白含量、CD3^+、CD3^+CD4^+水平在均较治疗前明显上升,且观察组的CD3^+、CD3^+CD4^+水平显著高于对照组(P<0.05)。观察组治疗期间不良反应发生率显著低于对照组(P=0.012)。结论:霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的临床效果较泼尼松联合环磷酰胺治疗更好,安全性更高。

Objective： To explore the clinical effect of mycophenolate mofetil combined with glucocorticosteroid on the children with anaphylatic purpura nephritis. Methods： 70 cases of children treated and diagnosed as anaphylatic purpura nephritis in our hospital from March, 2012 to September, 2015 were enrolled in this study. They were randomly divided into the observation group and the control group. Conventional therapy was applied to both groups, the observation group was treated by mycophenolate mofetil combined with prednisone, the control group was given cyclophosphamide combined with prednisone. The total effective rate, disappearence time of clinical symptoms, biochemical indicators, immune function as well as the incidence of adverse reactions were compared between the two groups. Results： The total effective rate of observation group was 94.29%, which was 85.17% in the control group, no statistical difference was found between two groups（P〉0.05）. After therapy, the disappearence time of albuminuria, hematnria in observation group showed no significant difference compared with those of the control group, the level of 24 h urine protein quantitation and CD19^＋ of both groups were significantly decreased, and the level of CD19^＋ of observation group was significantly lower than that of the control group （P〈0.05）, the level of albumin, total protein and CD3^＋, CD3^＋CD4^＋ of both groups were significantly increased, and the level of CD3^＋, CD3^＋CD4^＋ofobservation group were significantly higher than those of the control group （P〈0.05）. The incidence of adverse reactions in observation group was significantly lower than that of the control group （P 〈0.05）. Conclusion： Mycophenolate mofetil combined with glucocorticosteroid was more effective and safe on the children with anaphylatic purpura nephritis than that of cyclophosphamide combined with prednisone.