环磷酰胺治疗慢性肾小球肾炎疗效及其对血清MMP-2、肾组织PLA2R1水平的影响

The effect of immunosuppressive agents on chronic glomerulonephritis and the levels of serum MMP-2 and kindney tissue PLA2R1

目的观察环磷酰胺治疗慢性肾小球肾炎疗效及其对血清基质金属蛋白酶-2(MMP-2)、肾组织M型磷脂酶A2受体1(PLA2R1)水平的影响。方法选取2015年6月—2016年6月湖北省宜昌市第二人民医院肾内科收治的慢性肾小球肾炎患者76例作为研究对象,按随机数字表法分为2组。对照组38例,给予常规治疗;观察组38例,在对照组治疗基础上联合环磷酰胺治疗。比较2组治疗效果,观察血清尿素氮(BUN)、血肌酐(SCr)、24 h尿蛋白(24h UP)以及血清MMP-2、肾组织PLA2R1水平变化,并观察不良反应情况。结果观察组总有效率为92.10%,显著高于对照组的76.32%(χ~2=9.377,P<0.01);治疗后观察组血清BUN、SCr及24h UP水平分别为(3.02±0.38)mmol/L、(92.18±5.91)μmol/L、(0.43±0.16)g/24 h,均低于对照组(4.43±0.75)mmol/L、(112.37±8.12)μmol/L、(0.86±0.31)g/24 h,差异有统计学意义(t=9.778、11.722、7.187,P均<0.01);观察组治疗后血清MMP-2、肾组织PLA2R1水平分别为(0.94±0.17)、(51.21±1.26)%,均低于对照组(1.23±0.38)、(65.34±2.19)%,差异有统计学意义(t=4.062、32.609,P均<0.01);观察组不良反应发生率为5.26%,略高于对照组的2.63%,但差异无统计学意义(χ~2=0.912,P>0.05)。结论慢性肾小球肾炎患者在常规治疗基础上联合环磷酰胺治疗的效果较好,可缓解患者病情进展。

Objective To investigate the effect of immunosuppressive agents on the efficacy of chronic glomerulonephri- tis and serum levels of gelatinase （MMP-2） and M type phospholipase A2 receptor （PLA2RI）. Methods Seventy-six patients with chronic glomerulonephritis treated in our hospital from June 2015 to June 2016 were divided into two groups according to the random number table method. 38 cases of the control group were given conventional treatment, 38 cases of tile observation group were given immunosuppressive therapy on the basis of the control group; the levels of serum urea nitrogen （ BUN）, serum creati- nine （SCr）, 24h urinary protein （24h UP） and serum MMP-2 and PLA2R1 were compared between the two groups. Results The total efficiency of observation group （92.11%） was higher than the control group（76.32% ） （X2 =9. 377,P 〈0.05）. The levels of serum BUN, SCr and 24h UP in the observation group after the treatment were （3.02±0.38） mmol / L, （92. 18 ± 5.91 ） μmol / L, （0. 43± 0.16） g/24 h, which were lower than those in the control group （4.43 ± 0.75 ）mmol/L, （112.37 ± 8.12）μmol/L, （0.86 ± 0.31 ） g/2 h, the difference was statistically significant （ t = 9.778, t = 11. 722, t = 7. 187, P 〈 0. Ol ）. The levels of serum MMP-2 and PLA2R1 in the observation group after the treatment were （0. 94± 0. 17 ） and （51.21 ＋ 1.26）% respectively, which were lower than those in the control group （1.23±0.38） and （65.34±2.19）%, the difference was statistically （t =4.062,t =32. 609,P 〈0. 05）; The incidence of adverse reactions in the observation group was 5.26%, which was slightly higher than that in the control group （2.63%）, but the difference was not statistically significant （X2 =0.912, P 〉0. 05）. Conclusion Treatment of chronic glomerulonephritis with a combination of immunosuppressive agents on the basis of conventional treatment is good for patients with chronic glomerular nephritis, can alleviate the progress of patients with disease.