甲强龙与强的松联合恩替卡韦治疗原发性肾病综合征合并乙型肝炎的疗效对比

Comparison of the efficacy between methylprednisolone combined with entecavir and prednisone combined with entecavir in the treatment of primary nephrotic syndrome complicated with hepatitis B

目的探讨甲强龙与强的松治疗原发性肾病综合征合并乙型肝炎的疗效及其对患者免疫功能的影响。方法采用随机数字表法将74例原发性肾病综合征合并乙型肝炎患者随机分为甲强龙组和强的松组,每组各37例。两组均首先给予恩替卡韦治疗2周,2周后甲强龙组给予甲强龙治疗,强的松组给予强的松治疗。观察两组治疗2个月及6个月时24h尿蛋白定量、血白蛋白、肝功能、治疗前及治疗6个月时T淋巴细胞亚群;统计两组治疗效果和不良反应发生率。结果治疗2个月、6个月时甲强龙组24h尿蛋白均低于强的松组(P<0.01),血清白蛋白均高于强的松组(P<0.05);两组治疗2个月及6个月ALT、AST水平相比较差异均无统计学意义(P>0.05)。两组治疗6个月CD4+T细胞和CD4+/CD8+T细胞与治疗前相比较均显著降低(P<0.05),且甲强龙组与强的松组相比较两项指标均显著降低(P<0.05);两组治疗6个月CD8+T细胞与治疗前相比较升高更显著(P<0.05),且甲强龙组与同期强的松组相比较升高更显著(P<0.05)。甲强龙组肾脏临床治疗缓解率显著高于强的松组(P<0.05);两组肝脏治疗应答率和不良反应发生率相比较差异无统计学意义(P>0.05)。结论甲强龙联合恩替卡韦治疗肾病综合征合并乙型肝炎相对于强的松联合恩替卡韦可提高缓解率和临床疗效,改善免疫功能,具有临床推广价值。

Objective To investigate the efficacy of methylprednisolone and prednisone in the treatment of primary nephrotic syndrome complicated with hepatitis B and their effects on the immune function of patients.Methods Seventy-four patients with primary nephrotic syndrome complicated with hepatitis B were randomly divided into methylprednisolone group and prednisone group,with 37 cases in each group.Patients in both groups were treated with entecavir for 2 weeks.Methylprednisolone group was treated with methylprednisolone and prednisone group was treated with prednisolone after 2 weeks.The 24-hour urinary protein content,serum albumin,liver function in 2 months and 6 months after treatment as well as T lymphocyte subsets before treatment and after 6-month treatment in the two groups were observed,and the therapeutic efficacy and adverse reactions in the two groups were counted.Results The 24-hour urinary protein content in the methylprednisolone group was lower than that in the prednisone group in 2 months and 6 months after treatment(P<0.01),and the serum albumin content in the methylprednisolone group was higher than that in the prednisone group(P<0.05).There was no significant difference in ALT and AST content between the two groups in 2 months and 6 months after treatment(P >0.05).The CD4+T cells and CD4+/CD8+T cells in both groups in 6 months after treatment were significantly lower than those before treatment(P<0.05),and those two indexes of methylprednisolone group were significantly lower than those of prednisone group(P<0.05).CD8+T cells in both groups increased significantly in 6 months after treatment compared with those before treatment(P<0.05),and methylprednisolone group increased more significantly compared with prednisone group at the same time(P<0.05).The remission rate of renal clinical treatment in methylprednisolone group was significantly higher than that in prednisone group(P<0.05);there was no significant difference in liver response rate and adverse reaction rate between the two groups(P >0.05).Conclusion Compared with prednisone plus entecavir,methylprednisolone combined with entecavir in the treatment of nephrotic syndrome complicated with hepatitis B can increase the remission rate,improve the clinical efficacy and immune function,which has clinical application value.