环磷酰胺联合小剂量激素治疗膜性肾病的疗效观察及血清PLA2R 25(OH)D3 NGAL水平变化分析

Therapeutic Effect of Cyclophosphamide Combined with Low dose Hormone on Membranous Nephropathy and Analysis of Serum PLA2R 25(OH) D3 and NGAL Levels

目的:分析环磷酰胺联合小剂量激素治疗膜性肾病的疗效及血清磷脂酶A2受体(PLA2R)、25-羟维生素D3(25(OH) D3)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平变化。方法:选取2015年4月至2018年3月我院收治的87例膜性肾病患者,根据简单随机分组法分为观察组(42例)和对照组(45例)。对照组使用环磷酰胺,观察组联合小剂量激素治疗。比较两组患者临床疗效,24h尿蛋白定量、血清总胆固醇、血清肌酐、血清白蛋白,血清PLA2R、25(OH) D3、NGAL水平。结果:治疗后,观察组临床总有效率显著高于对照组(P<0.05)。治疗前,两组患者24h尿蛋白定量、血清总胆固醇、血清肌酐、血清白蛋白比较无显著差异(P>0.05),治疗1个月、3个月、6个月后,两组患者24h尿蛋白定量呈降低趋势(P <0.05),但观察者始终低于对照组(P <0.05),血清白蛋白呈上升趋势(P <0.05),观察者始终高于对照组(P <0.05),两组患者的24h尿蛋白定量、血清白蛋白在组间、不同时间点、组间·不同时间点交互效应比较差异有统计学意义(P<0.05),治疗1个月、3个月、6个月后,两组血清总胆固醇、血清肌酐呈下降趋势(P<0.05),但两组比较无显著差异(P>0.05)。治疗前,两组血清PLA2R、25(OH) D3、NGAL水平比较无显著差异(P> 0. 05),治疗1个月、3个月、6个月后,两组血清PLA2R、NGAL水平呈下降趋势(P <0.05),观察组始终低于对照组(P <0.05),两组血清25(OH) D3水平呈上升趋势(P<0.05),观察组始终高于对照组(P<0.05),两组在组间、不同时间点、组间·不同时间点交互效应比较差异有统计学意义(P<0.05)。观察组和对照组不良反应率比较无显著差异(P>0.05)。结论:环磷酰胺联合小剂量激素治疗膜性肾病能有效降低患者血清PLA2R、NGAL水平,升高血清25(OH) D3水平,改善患者临床症状,临床疗效良好,安全性较高。

Objective:To analyze the efficacy of cyclophosphamide combined with low-dose hormone in the treatment of membranous nephropathy and the level of serum phospholipase A2 receptor(PLA2R),25-dihydroxyvitamin D3(25(OH)D3),neutrophil gelatinase-associated lipocalin(NGAL)changes.Methods:Eighty-seven patients with membranous nephropathy admitted to our hospital from April 2015 to March 2018 were enrolled,they were divided into the observation group(42 cases)and the control group(45 cases)according to simple random grouping method.The control group was treated with cyclophosphamide,and the observation group was treated with small doses of hormone on the basis of control group.The clinical efficacy,24h urine protein quantitation,serum total cholesterol,serum creatinine,serum albumin,serum PLA2R,25(OH)D3,NGAL levels of the two groups was compared.Results:After treatment,the total clinical effective rate of the observation group was significantly higher than that of the control group(P<0.05).Before treatment,there was no significant difference in 24h urine protein quantitation,serum total cholesterol,serum creatinine and serum albumin between the two groups(P>0.05).After 1 month,3 months and 6 months of treatment,the two groups of patients with 24h urine protein quantification showed a decreasing trend(P<0.05),but the observation group were always lower than the control group(P<0.05),serum albumin showed a increasing trend(P<0.05),and the observation group were always higher than the control group(P<0.05).There were significant differences in 24h urine protein quantitation and serum albumin between groups,at different time points,between groups,and at different time points(P<0.05).After the 1 month,3 months,6 months treatment,serum total cholesterol and serum creatinine showed a downward trend(P<0.05),but there was no significant difference between the two groups(P>0.05).Before treatment,there was no significant difference in serum levels of PLA2R,25(OH)D3 and NGAL between the two groups(P>0.05).After 1 month,3 months and 6 months of treatment,the levels of serum PLA2R and NGAL decreased.(P<0.05),the observation group was always lower than the control group(P<0.05),the serum 25(OH)D3 level of the two groups showed an increasing trend(P<0.05),and the observation group was always higher than the control group(P<0.05).There were significant differences in the interaction between the two groups at different time points,between groups,and at different time points(P<0.05).There was no significant difference in the adverse reaction rate between the observation group and the control group(P>0.05).Conclusion:Cyclophosphamide combined with low-dose hormones can effectively reduce the level of PLA2R and NGAL,increase the level of serum 25(OH)D3 and improve the clinical symptoms of patients with membranous nephropathy.The clinical efficacy is good and the safety is high.