左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效及对血清sPD-1 sPD-L1的影响

Efficacy of Levamisole Combined with Glucocorticoid in Treating Primary Nephrotic Syndrome of Children and Its Effects on Serum SPD-1 and SPD-L1 Levels

目的:探讨左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效及对血清可溶性程序性死亡受体1(sPD-1)、可溶性程序性死亡受体配体1(sPD-L1)的影响。方法:选择2016年1年至2018年10月我院接诊的原发性肾病综合征患儿90例,通过随机数表法,分为观察组和对照组,每组45例,在基础治疗上,对照组给予醋酸泼尼松片治疗,观察组联合左旋咪唑治疗。连续治疗8周后,比较两组临床疗效、24h尿蛋白定量、白蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)、免疫球蛋白(Ig)、T淋巴细胞亚群、血清sPD-1、sPD-L1的变化及6个月复发率。结果:治疗后,观察组临床疗效总有效率明显高于对照组(95.56%vs82.22%)(P<0.05);观察组24h尿蛋白定量、TC、TG分别为(0.35±0.08)g、(5.05±0.74)mmoL/L、(1.35±0.20)mmoL/L,均明显低于对照组的(0.74±0.19)g、(5.82±0.69)mmoL/L、(1.69±0.23)mmoL/L,观察组ALB为(38.94±3.71)g/L,明显高于对照组的(34.12±3.90)g/L,差异均有统计学意义(P<0.05);观察组IgG、IgA、IgM、CD4+、CD4+/CD8+分别(9.21±1.68)g/L、(0.90±0.15)g/L、(1.48±0.12)g/L、(40.23±2.17)%、(1.52±0.19),明显高于对照组的(7.65±1.84)g/L、(0.79±0.13)g/L、(1.33±0.09)g/L、(37.46±2.29)%、(1.38±0.15),差异均有统计学意义(P<0.05);观察组血清sPD-1、sPD-L1分别为(1.11±0.25)ng/mL、(69.56±7.40)pg/mL,均明显低于对照组(1.63±0.36)ng/mL、(82.36±8.27)pg/mL,差异均有统计学意义(P<0.05);随访6个月显示,观察组复发率明显低于对照组(7.00%vs20.00%)(P<0.05)。结论:左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效明显,有助于改善实验室指标、减少复发率,其内在机制可调节免疫功能及血清sPD-1、sPD-L1相关,值得应用推广。

Objective:To study the curative efficacy of levamisole combined with glucocorticoid in treatment of children with primary nephrotic syndrome and its effects on serum soluble programmed death receptor 1(sPD-1)and soluble programmed death receptor ligand 1(sPD-L1)levels.Methods 90 children with primary nephrotic syndrome who received therapy from January 2016 to October 2018 in our hospital were selected,according to the random number table,and they were divided into the observation group and the control group,45 cases in each.Besides basic treatment,the control group was treated with prednisone acetate tablets,and the observation group was additionally administered levamisole.After continuous treatment of 8 weeks,the clinical efficacy,the changes of the 24-hour urine protein quantity,albumin(ALB),total cholesterol(TC),triglyceride(TG),immunoglobulin(Ig),T lymphocyte subsets,serum sPD-1,sPD-L1 and recurrence rate of 6 months were compared between the two groups.Results:After treatment,the total effective rate of the observation group was significantly higher than that the control group(95.56%vs82.22%)(P<0.05);the 24-hour urine protein quantity,TC,TG in the observation group were(0.35±0.08)g,(5.05±0.74)mmol/L and(1.35±0.20)mmol/L,which were significantly lower than the control group(0.74±0.19)g,(5.82±0.69)mmol/L and(1.69±0.23)mmol/L.The ALB in observation group were(38.94±3.71)g/L,which were significantly higher than the control group(34.12±3.90)g/L,anf the difference was statistically significant(P<0.05);the IgG,IgA,IgM,CD4+and CD4+/CD8+were(9.21±1.68)g/L,(0.90±0.15)g/L,(1.48±0.12)g/L,(40.23±2.17)%,(1.52±0.19),which were significantly higher than the control group(7.65±1.84)g/L,(0.79±0.13)g/L,(1.33±0.09)g/L,(37.46±2.29)%,(1.38±0.15),and the difference was statistically significant(P<0.05);the serum sPD-1,sPD-L1 in the observation group were(1.11±0.25)ng/ml and(69.56±7.40)pg/ml,which were significantly lower than the control group(1.63±0.36)ng/ml and(82.36±8.27)pg/ml,the difference was statistically significant(P<0.05);the follow-up for 6 months showed that the recurrence rate in the observation group was significantly lower than that in the control group(7.00%vs20.00%)(P<0.05).Conclusion:Levamisole combined with glucocorticoid is effective for children with primary nephrotic syndrome,which can effectively improve the laboratory indexes and reduce the recurrence rate.It's internal mechanism may regulate the immune function and serum sPD-1 and sPD-L1,and it's worth popularizing.