丙种球蛋白结合甲基强的松龙治疗紫癜性肾炎的疗效及其对患者T细胞免疫的影响

Effect of gamma globulin combined with methylprednisolone on purpura nephritis and its influence on T-cell immunity

目的观察丙种球蛋白结合甲基强的松龙治疗紫癜性肾炎(HSPN)的疗效,并探讨其对患者T细胞免疫的影响。方法将2014年3月至2016年3月在孝感市中心医院肾内科就诊的90例HSPN患者采用随机数表法分为观察组和对照组各45例,对照组给予甲基强的松龙治疗,观察组给予丙种球蛋白结合甲基强的松龙治疗。治疗4周后,比较两组患者的临床疗效,以及治疗前后血肌酐(SCr)、尿素氮(BUN)、尿β_2-微球蛋白(β_2-MG)和T细胞水平的变化。结果观察组患者的治疗总有效率为88.89%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);治疗后,观察组患者的血清SCr、BUN及尿β_2-MG水平分别为(115.25±23.38)μmol/mL、(7.59±1.89)mmol/L和(1.42±0.59)mg/L,均明显低于对照组的(147.65±29.75)μmol/mL、(9.87±1.96)mmol/L和(1.92±0.86)mg/L,差异均有统计学意义(P<0.05);观察组患者治疗后血CD3^+、CD4^+及CD4^+/CD8^+值分别为(68.76±4.87)%、(37.88±3.45)%和(1.38±0.20),均明显高于对照组的(63.19±4.56)%、(34.71±3.05)%、(1.19±0.25),差异均有统计学意义(P<0.05);治疗过程中观察组不良反应发生率为8.89%,明显低于对照组20.00%,差异有统计学意义(P<0.05)。结论丙种球蛋白联合甲基强的松龙治疗HSPN的疗效显著,其能够明显改善患者肾功能、调节机体免疫,且具有较高安全性。

Objective To observe the effect of gamma globulin combined with methylprednisolone on purpura nephritis（HSPN）, and to investigate its influence on T-cell immunity of patients. Methods A total of 90 patients with HSPN, who admitted to Department of Nephrology of Xiaogan Central Hospital from March 2014 to March 2016,were selected and divided into the observation group and the control group according to random number table, with 45 cases in each group. The patients in the control group were given methylprednisolone, and those in the observation group were given gamma globulin combined with methylprednisolone. After 4 weeks of treatment, the clinical effects of two groups were observed. The changes of serum creatinine（SCr）, blood urea nitrogen（BUN）, urine β2-microglobulin（β2-MG） and T-lymphocyte subsets in two group were compared before and after the treatment. Results The total effective rate of the observation group was 88.89%, which was significantly higher than and 73.33% of the control group（P0.05）. After the treatment, the levels of serum SCr, BUN and urine β2-MG in the observation group were（115.25±23.38） μmol/mL,（7.59±1.89） mmol/L,（1.42±0.59） mg/L, respectively, which were significantly lower than corresponding（147.65±29.75） μmol/mL,（9.87±1.96） mmol/L and（1.92±0.86） mg/L of the control group（P0.05）, while the levels of CD3~＋, CD4~＋and CD4~＋/CD8~＋in the observation group after the treatment were（68.76 ± 4.87）%,（37.88 ±3.45）%,（1.38±0.20）, respectively, which were significantly higher than corresponding（63.19±4.56）%,（34.71±3.05）%,（1.19±0.25） of the control group（P0.05）. The rate of adverse effect in the observation group was 8.89%, which was significantly lower than 20.00% in the control group（P0.05）. Conclusion Gamma globulin combined with methylprednisolone has precise efficacy in the treatment of HSPN. It can improve renal function, regulate the body＇s immunity and be worthy of clinic application.