霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎的疗效及其对患者血清CysC、TGF-β_1、sTM的影响

Efficacy of Mycophenolate combined with Irbesartan in the treatment of lupus nephritis and its effect on serum CysC, TGF-β_1and sTM

目的探讨霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎的疗效及其对患者血清胱抑素C (CysC)、转化生长因子-β_1(TGF-β_1)、可溶性血栓调节蛋白(sTM)水平的影响。方法从上海利普陀区立群医院2015年7月至2017年7月收治的狼疮性肾炎患者中选取86例作为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组给予厄贝沙坦治疗,观察组给予霉酚酸酯联合厄贝沙坦治疗,持续治疗6个月。治疗后比较两组患者的临床疗效、临床症状改善情况、CysC、TGF-β_1、sTM、尿白蛋白排泄率(UAER)、尿β2微球蛋白(β2-MG)、24 h尿蛋白量、血白蛋白、血清肌酐(Scr)、补体C3水平及不良反应发生率。结果观察组患者的治疗总有效率为95.35%,明显高于对照组的79.07%,差异有统计学意义(P<0.05);治疗后观察组患者的尿蛋白转阴、水肿消退、血压恢复正常、血尿消失、肾功能恢复正常等改善情况明显优于对照组,差异均有统计学意义(P<0.05);治疗后两组患者的CysC、TGF-β_1、sTM水平与治疗前相比均明显降低,差异均有统计学意义(P<0.05),且观察组患者的CysC、TGF-β_1、sTM水平[(1.23±0.34) mg/L、(51.92±9.86) pg/mL、(12.23±3.18) ng/mL]均明显低于对照组[(1.65±0.45) mg/L、(56.86±10.79) pg/mL、(29.15±7.06) ng/mL],差异均有统计学意义(P<0.05);治疗后两组患者的UAER、尿β2-MG、24 h尿蛋白量、血白蛋白、Scr水平与治疗前相比明显降低,C3水平明显升高,且组间比较差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为6.98%,与对照组的4.65%比较差异无统计学意义(P>0.05)。结论霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎能显著改善患者临床症状,下调血清CysC、TGF-β_1、s TM表达,调节UAER、尿β2-MG、24 h尿蛋白量、血白蛋白、Scr、C3水平恢复正常,减轻患者肾脏损伤,促进肾功能改善,且安全性较高。

Objective To investigate the effect of Mycophenolate combined with Irbesartan on clinical efficacy and the effect on serum cystatin C（CysC）, transforming growth factor-β1（TGF-β1） and soluble thrombomodulin（sTM） in patients with lupus nephritis. Methods A total of 86 patients with lupus nephritis treated in Shanghai Putuo Liqun Hospital from July 2015 to July 2017 were selected as the research subjects. They were divided into observation group and control group according to the random number table method, with 43 cases in each group. The control group was treated with Irbesartan, and the observation group was given Mycophenolate combined with Irbesartan; the two groups were treated for 6 months. After treatment, the clinical curative effect, clinical symptom improvement, CysC,TGF-β1, sTM, urinary albumin excretion rate（UAER）, urinary β2 microglobulin（β2-MG）, 24 h urine protein, serum albumin, serum creatinine（Scr）, complement C3 levels and incidence of adverse reactions were compared between two groups of patients. Results The total effective rate of treatment in the observation group was 95.35%, which was significantly higher than 79.07% in the control group（P〈0.05）. After treatment, the improvement in the observation group was significantly better than that in the control group, including urine protein negative conversion, edema regression, blood pressure recovery, hematuria disappearance and renal function recovery（P〈0.05）. After treatment, the levels of CysC,TGF-β1 and sTM in the two groups were significantly lower than those before treatment（P〈0.05）. The levels of CysC,TGF-β1 and s TM in the observation group were（1.23±0.34） mg/L,（51.92±9.86） pg/mL,（12.23±3.18） ng/mL, respectively, significantly lower than（1.65±0.45） mg/L,（56.86±10.79） pg/mL,（29.15±7.06） ng/mL in the control group（P〈0.05）.After treatment, the levels of UAER, urine β2-MG, 24 h urine protein, serum albumin and Scr were significantly lower than those before treatment, and C3 levels were significantly increased（P〈0.05）. The incidence of adverse reactions in the observation group was 6.98%, which was not statistically significant compared with 4.65% in the control group（P〉0.05）. Conclusion Mycophenolate combined with Irbesartan in the treatment of lupus nephritis can significantly improve the clinical symptoms of patients, reduce the expressions of serum CysC, TGF-β1 and sTM, regulate UAER, urineβ2-MG, 24 h urine protein, serum albumin, Scr, C3 levels to normal, alleviate renal injury, promote renal function improvement, and has high safety.