单独抗病毒与抗病毒+激素治疗小儿乙型肝炎病毒相关性肾炎的价值

Value of cyclophosphamide alone and cyclophosphamide combined with steroids in the treatment of hepatitis B virus-associated glomerulonephritis in children

目的研究单独抗病毒与抗病毒+激素治疗小儿乙型肝炎病毒相关性肾炎(HBV-GN)的价值。方法选取河南科技大学第一附属医院2017年7月至2019年7月收治的HBV-GN患儿82例,患儿入院后依据用药方式的不同分为A组41例与B组41例。B组给予环磷酰胺片治疗,A组在B组基础上加用激素治疗。两组用药6个月后评估临床治疗效果,对比治疗前后肝肾功能指标ALT、AST、肾小球滤过率(GFR)、白蛋白水平变化,及其在用药期间不良反应发生率。结果A组总有效率显著高于B组,80.49%(33/41)比58.54%(24/41),差异有统计学意义(P<0.05)。A组治疗后3、6个月ALT、AST水平分别为(49.21±8.02)U/L、(72.23±8.02)U/L、(35.43±5.11)U/L、(42.30±4.12)U/L,低于治疗前的(74.53±12.43)U/L、(82.74±10.25)U/L及B组治疗后的(54.72±8.45)U/L、(77.21±8.54)U/L、(42.56±5.58)U/L、(48.53±5.83)U/L,差异有统计学意义(P<0.05);A组治疗后3、6个月GFR、白蛋白水平分别为(69.42±13.66)mL·min、(28.54±7.21)g/L、(84.22±15.54)mL·min、(33.52±8.06)g/L,高于治疗前的(58.21±10.53)mL·min、(20.35±5.13)g/L及B组治疗后的(63.25±12.53)mL·min、(24.53±6.18)g/L、(75.58±14.85)mL·min、(29.54±7.25)g/L,差异有统计学意义(P<0.05)。A、B组用药期间不良反应总发生率分别为17.07%(7/41)和9.76%(4/41),差异无统计学意义(P>0.05)。结论与单独抗病毒治疗相比,抗病毒+激素方案用于HBV-GN患儿可更好的改善肝肾功能,临床疗效显著,且用药安全。

Objective To study the value of cyclophosphamide and cyclophosphamide+hormone in the treatment of pediatric hepatitis B virus-associated glomerulonephritis(HBV-GN).Methods Eighty-two cases of children with HBV-GN admitted to our hospital from July 2017 to July 2019 were randomly selected as research objects.After admission,the children were divided into group A(n=41)and group B(n=41)according to different medication methods.Group B was treated with cyclophosphamide tablets,and group A was treated with hormone and cyclophosphamide tablets.The clinical therapeutic effect of the 2 groups was evaluated after 6 months of administration,and the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),glomerular filtration rate(GFR)and albumin(ALB)were compared before and after treatment.Besides,the incidence of adverse reactions during administration was calculated.Results The total effective rate of group A was significantly higher than that of group B(80.49%vs 58.54%,P<0.05).The ALT and AST levels 3 and 6 months after treatment of group A[(49.21±8.02)U/L,(72.23±8.02)U/L,(35.43±5.11)U/L,(42.30±4.12)U/L)]were significantly lower than those before treatment[(74.53±12.43)U/L,(82.74±10.25)U/L],and those of group B[(54.72±8.45)U/L,(77.21±8.54)U/L,(42.56±5.58)U/L,(48.53±5.83)U/L),P<0.05].The GFR and ALB levels of group A 3 and 6 months after treatment[(69.42±13.66)mL/min,(28.54±7.21)g/L,(84.22±15.54)mL/min,(33.52±8.06)g/L]were significantly lower than those before treatment[(58.21±10.53)mL/min,(20.35±5.13)g/L],and those of group B[(63.25±12.53)mL/min,(24.53±6.18)g/L,(75.58±14.85)mL/min,(29.54±7.25)g/L,P<0.05].There was no significant difference in the incidence of adverse reactions(17.07%vs 9.76%)between the 2 groups(P>0.05).Conclusion Compared with cyclophosphamide alone,the combination of cyclophosphamide and hormone in the treatment of children with HBV-GN can improve their liver and kidney function better,with significant clinical efficacy and good safety.