环孢素治疗儿童肾病综合征的临床效果观察

Clinical effect observation of cyclosporine in children with nephrotic syndrome

目的探讨环孢菌素A(cyclosporine A,CsA)治疗原发性肾病综合征(primary nephrotic syndrome,PNS)患儿的疗效及对Toll样受体(TLRs)表达的影响。方法选取本院2016年1月至2018年12月肾病内科收治的100例PNS患儿,采用随机数字表法分为研究组(泼尼松+CsA)和对照组(泼尼松+霉酚酸酯)各50例。研究组男32例,女18例,年龄(6.5±2.3)岁;对照组男29例,女21例,年龄(6.4±3.0)岁。治疗6个月后进行疗效评价;对比两组患儿治疗前后外周血中Toll样受体3(TLR3)mRNA、Toll样受体9(TLR9)mRNA、转化生长因子β1(TGF-β1)mRNA、白细胞介素-18(IL-18)mRNA、人血白TLR3 mRNA蛋白、胆固醇的表达变化、不良反应发生率。结果治疗前,两组患儿TLR3 mRNA、TLR9 mRNA水平比较差异均无统计学意义(均P>0.05);治疗后,研究组的TLR3 mRNA[(0.501±0.116)/βactin比(0.648±0.150)/βactin]、TLR9 mRNA[(1.332±0.260)/βactin比(1.476±0.258)/βactin]表达水平均低于对照组(均P<0.05);治疗前,两组患儿TGF-β1 mRNA、IL-18 mRNA水平比较差异均无统计学意义(均P>0.05);治疗后,研究组的TGF-β1 mRNA表达水平低于对照组[(0.153±0.051)/βactin比(0.178±0.048)/βactin,P<0.05];在治疗3个月后,研究组患儿的整体疗效分布优于对照组(P<0.05),但是在治疗6个月后,两组患儿的整体疗效分布比较差异无统计学意义(P>0.05);治疗前,两组患儿人血白蛋白、胆固醇水平比较差异均无统计学意义(均P>0.05);治疗后,研究组的胆固醇水平低于对照组,差异有统计学意义(P<0.05)。结论激素+CsA较激素+霉酚酸酯治疗PNS患儿对TLR3 mRNA、TLR9 mRNA、TGF-β1 mRNA的调节作用更显著,早期临床效果更好。

Objective To explore the efficacy of cyclosporine A(CsA)in the treatment of children with primary nephrotic syndrome(PNS)and its influence on the expression of TLRs.Methods A total of 100 children with PNS admitted to the Department of Nephrology of our hospital from January 2016 to December 2018 were selected and were divided into study group[32 males,18 females,aged(6.5±2.3),hormone+CsA]and control group[29 males,21 females,aged(6.4±3.0),hormone+mycophenolate mofetil]with the random number table,50 cases in each group.The curative effect was evaluated after 6 months of treatment.The expression changes of TLR3 mRNA,TLR9 mRNA,TGF-β1 mRNA,IL-18 mRNA,serum albumin,cholesterol in the peripheral blood of the two groups before and after treatment and the incidences of adverse reactions were compared.Results Before treatment,there were no statistically significant differences in TLR3 mRNA and TLR9 mRNA levels between the study group and the control group(both P>0.05);after treatment,the expression levels of TLR3 mRNA[(0.501±0.116)/βactin vs.(0.648±0.150)/βactin]and TLR9 mRNA[(1.332±0.260)/βactin vs.(1.476±0.258)/βactin]in the study group were lower than those in the control group(both P<0.05).Before treatment,there were no statistically significant differences in the levels of TGF-β1 mRNA and IL-18 mRNA between the study group and the control group(both P>0.05);after treatment,the expression level of TGF-β1 mRNA in the study group was lower than that in the control group[(0.153±0.051)/βactin vs.(0.178±0.048)/βactin,P<0.05].After 3 months of treatment,the overall efficacy distribution of children in the study group was better than that in the control group(P<0.05).However,after 6 months of treatment,there was no statistically significant difference in the overall efficacy distribution between the study group and the control group(P>0.05).Before treatment,there were no statistically significant differences in albumin and cholesterol levels between the study group and the control group(both P>0.05);after treatment,the cholesterol level of the study group was lower than that of the control group(P<0.05).Conclusion Hormone+CsA has a more significant regulatory effect on TLR3 mRNA,TLR9 mRNA,and TGF-β1 mRNA than hormone+mycophenolate mofetil in children with PNS,with better early clinical effect.