环孢素A联合甲泼尼龙与恩替卡韦治疗合并乙型肝炎病毒感染的原发性肾病综合征疗效及安全性

Clinical Efficacy and Safety of Cyclosporine A Combined with Methylprednisolone and Entecavir in the Treatment of Primary Nephrotic Syndrome Complicated with Hepatitis B Virus Infection

目的探讨环孢素A联合甲泼尼龙与恩替卡韦治疗合并乙型肝炎病毒(HBV)感染的原发性肾病综合征的疗效及安全性。方法选取医院2015年4月至2017年7月收治的原发性肾病综合征合并HBV感染患者42例,按治疗方式的不同分为治疗组与对照组,各21例。两组患者均给予抗凝、控制血压、纠正电解质酸碱平衡、营养支持常规治疗和对症治疗,对照组患者给予恩替卡韦联合甲泼尼龙冲击治疗,治疗组患者在对照组患者基础上加用环孢素A治疗。结果治疗组临床总有效率为90. 48%,明显高于对照组的71. 43%(P <0. 05);治疗后,两组患者的血清肌酐(SCr)、24 h尿蛋白定量、血尿素氮(BUN)及丙氨酸氨基转移酶(ALT)和天门冬酸氨基转移酶(AST)水平明显低于治疗前,血浆白蛋白(ALB)水平明显高于治疗前,且治疗组明显优于对照组(P <0. 05);治疗组不良反应发生率为14. 29%,低于对照组的33. 33%(P <0. 05)。结论环孢素A联合甲泼尼龙与恩替卡韦治疗原发性肾病综合征合并HBV感染疗效理想,可有效降低患者24 h尿蛋白定量,改善患者临床症状,同时可有效抑制HBV-DNA复制,降低肝功能损伤,且不增加治疗后的不良反应,对改善患者预后和生存质量有积极意义。

Objective To investigate the clinical efficacy and safety of cyclosporine A combined with metbylprednisolone and entecavir in the treatment of primary nephrotic syndrome complicated with hepatitis B virus（HBV） infection. Methods Totally 42 patients with primary nephrotic syndrome complicated with HBV infection admitted to our hospital from April 2015 to July 2017 were selected and divided into the treatment group and the control group, 21 cases in each group. The two groups were given anticoagulation, blood pressure control, electrolyte acid-base balance correction, nutritional support routine treatment and symptomatic treatment. The control group was treated with entecavir combined with methylprednisolone, on this basis, the treatment group was treated with cyclosporine A. Results The total effective rate of the treatment group was 90.48%, which was significantly higher than 71.43% of the control group（P 〈 0.05）. After treatment, the levels of serum creatinine（SCr）, 24 h urine protein quantitation, blood urea nitrogen（BUN）, alanine aminotransferase（ALT） and aspartate aminotransferase（AST） in the two groups were significantly lower than those before treatment, while the levels of plasma albumin （ALB） in the two groups were significantly higher than those before treatment, and those in the treatment group were significantly better than those in the control group（P 〈 0.05）. The incidence rate of adverse reactions in the treatment group was 14. 29%, which was lower than 33.33% in the control group（P 〈 0.05）. Conclusion Cyclosporine A combined with methylprednisolone and entecavir is eft-ctive in the treatment of primary nephrotic syndrome complicated with HBV infection, it can eft-ctively reduce 24 h urine protein quantita- tion, improve the clinical symptoms of patients. At the same time, it can eft-ctively inhibit HBV- DNA replication, reduce liver function damage without increasing the adverse reactions after treatment, which has positive significance for improving prognosis and quality of life of patients.