他克莫司与肾炎康复片对抗中性粒细胞胞质抗体相关肾炎患者sFlt-1及LAMP-2的影响比较

Comparison of the effects of tacrolimus and Shenyankangfu tablets on sFlt-1 and LAMP-2 in patients with neutrophil cytoplasmic antibody associated glomerulonephritis

目的比较他克莫司与肾炎康复片对抗中性粒细胞胞质抗体(ANCA)相关肾炎患者可溶性血管内皮细胞生长因子受体1(s Flt-1)及溶酶体相关膜蛋白2(LAMP-2)的影响。方法选取2015年1月-2019年1月湖北省五峰土家族自治县人民医院、湖北省宜昌市第一人民医院诊治的ANCA相关肾炎患者80例,采用双盲法随机分为他克莫司组和肾炎康复片组,每组40例,分别接受他克莫司与肾炎康复片治疗。比较2组患者临床疗效,治疗前后s Flt-1、LAMP-2、血管内皮细胞生长因子(VEGF)、血尿酸(UA)、视黄醇结合蛋白(RBP)、Ⅳ型胶原(Co I-Ⅳ)水平及不良反应。结果他克莫司组患者完全缓解率、临床总有效率高于肾炎康复片组(χ2/P=8.584/0.003,4.021/0.045)。治疗后,2组患者s Flt-1、LAMP-2抗体、VEGF及UA、RBP、Co I-Ⅳ水平均低于治疗前,且他克莫司组低于肾炎康复片组(P <0.01)。他克莫司组患者不良反应总发生率为12.50%,肾炎康复片组为10.00%,2组比较差异无统计学意义(χ2=0.125,P=0.723)。结论他克莫司治疗ANCA相关肾炎的效果优于肾炎康复片,能明显抑制ANCA相关肾炎患者s Flt-1、LAMP-2等细胞因子水平,保护血管内皮功能及肾功能,值得临床推荐使用。

Objective To compare the effects of tacrolimus and Shenyankangfu tablets on soluble vascular endothelial growth factor receptor-1( s Flt-1) and lysosome associated membrane protein-2( LAMP-2) in patients with antineutrophil cytoplasmic antibody( ANCA) associated glomerulonephritis. Methods From January 2015 to January 2019,80 patients with ANCA-related nephritis diagnosed and treated by the People’s Hospital of Wufeng Tujia Autonomous County in Hubei Province and the First People’s Hospital of Yichang City in Hubei Province were selected. Using double-blind method,they were randomly divided into tacrolimus group and Shenyankangfu tablets group,with 40 cases in each group,they were treated with tacrolimus and Shenyankangfu tablets respectively. The clinical efficacy,s Flt-1,LAMP-2,vascular endothelial cell growth factor( VEGF),blood uric acid( UA),retinol binding protein( RBP),Ⅳcollagen( Co I-Ⅳ) level before and after treatment and adverse reactions in the two groups were compared. Results The CR rate and total clinical effective rate in the tacrolimus group were higher than those in the Shenyankangfu tablets group( χ2/P = 8. 584/0. 003,4. 021/0. 045). After treatment,the levels of s Flt-1,LAMP-2 antibody,VEGF and UA,RBP,Co I-Ⅳin the two groups were lower than before treatment,and the tacrolimus group was lower than the Shenyankangfu tablet group( P < 0. 01). The total incidence of adverse reactions in the tacrolimus group was 12. 50%,which was higher than the 10. 00% in the Shenyankangfu tablets group,but the difference was not statistically significant( χ2= 0. 125,P = 0. 723). Conclusion The effect of tacrolimus in the treatment of ANCA associated glomerulonephritis is better than that of Shenyankangfu tablets. Tacrolimus can significantly inhibit the levels of s Flt-1,LAMP-2 and other cytokines in patients with ANCA associated glomerulonephritis,protect vascular endothelial function and renal function,which is worthy of clinical recommendation.