咪唑立宾治疗儿童紫癜性肾炎的疗效与安全性

Effect and safety of mizoribine on Henoch-Sch nlein purpura nephritis in children

目的探讨咪唑立宾(MZR)治疗儿童紫癜性肾炎(HSPN)的疗效与安全性。方法选择2016年1月至2017年10月东部战区总医院儿科收治的儿童HSPN55例,按照随机数字分组法随机分为2组:强的松(PDN)与MZR联合治疗组(联合组,n=38)和MZR单药治疗组(单药组,n=17)。分析2组患儿的随访3个月、6个月、12个月和24个月实验室检查结果、预后和不良反应。结果联合组6个月、12个月和24个月ALB水平高于基线值(P<0.05);单药组12个月和24个月ALB水平高于基线值(P<0.05);联合组6个月、12个月和24个月尿蛋白定量水平低于基线值(P<0.05,P<0.01);单药组12个月和24个月尿蛋白定量水平低于基线值(P<0.05,P<0.01);联合组3个月、6个月、12个月和24个月尿NAG酶水平低于基线值(P<0.01);单药组6个月、12个月和24个月尿NAG酶水平低于基线值(P<0.05,P<0.01);联合组6个月、12个月和24个月尿RB蛋白水平低于基线值(P<0.05,P<0.01);单药组12个月和24个月尿RB蛋白水平低于基线值(P<0.01)。预后分级:A级和总体预后分级联合组高于单药组(97.37%vs 82.35%,P<0.05),B级预后分级联合组低于单药组(2.63%vs 17.65%,P<0.05)。联合组尿蛋白消失比例明显高于单药组(P<0.01)。联合组血WBC升高比例高于单药组(86.84%vs 58.82%,P<0.05),呼吸道感染次数高于单药组(63.16%vs 23.53%,P<0.05),HSP复发次数低于单药组(2.63%vs 17.65%,P<0.05)。结论MZR治疗儿童HSPN有效性和安全性较高,PDN联合MZR治疗HSPN的临床效果高于单药MZR,且长期预后好于单药MZR。

Objective To investigate the efficacy and safety of mizoribine(MZR)in children with Henoch-Sch nlein purpura nephritis(HSPN).Methods From January 2016 to October 2017,55 cases of children with HSPN admitted to the Department of Paediatrics of Jinling Hospital were analyzed.According to the treatment,all patients were divided into prednisone(PDN)and MZR combined treatment groups(PDN+MZR group,n=38)and MZR monotherapy group(MZR group,n=17).The laboratory test results of 3 mouths,6 mouths,12 mouths and 24 mouths follow-up time,prognosis and adverse reactions of the two groups of children were analyzed.Results At the follow-up time of 6 mouths,12 mouths and 24 mouths,the albumin(ALB)levels in PDN+MZR group were higher than the baseline(P<0.05).At 12 mouths and 24 mouths time,the ALB levels in MZR group were higher than the baseline(P<0.05).At 6 mouths,12 mouths and 24 mouths time,urine protein level in PDN+MZR group were lower than the baseline(P<0.05,P<0.01).At 12 mouths and 24 mouths time,urine protein level in MZR group were lower than the baseline(P<0.05,P<0.01).At 3 mouths,6 mouths,12 mouths and 24 mouths time,the urinary NAG enzyme level in PDN+MZR group were lower than the baseline(P<0.01).At 6 mouths,12 mouths and 24 mouths time,the urinary NAG enzyme level in MZR group were lower than the baseline(P<0.05,P<0.01).At 6 mouths,12 mouths and 24 mouths time,the urinary RB protein levels in PDN+MZR group were lower than the baseline(P<0.05,P<0.01).At 12 mouths and 24 mouths time,the urine RB protein level in the MZR group was lower than the baseline(P<0.01).A prognosis classification and overall prognosis classification in PDN+MZR group was higher than that in MZR group(97.37%vs 82.35%,P<0.05).B prognosis classification in PDN+MZR group was lower than that in MZR group(2.63%vs 17.65%,P<0.05).The percentage of urinary protein disappearance in PDN+MZR group was higher than that in MZR group(P<0.01).The proportion of increased blood WBC in the PDN+MZR group was higher than that in MZR group(86.84%vs 58.82%,P<0.05).The number of respiratory infections in the PDN+MZR group was higher than that in MZR group(63.16%vs 23.53%,P<0.05).And the number of HSP recurrences in the PDN+MZR group was lower than that in MZR group(2.63%vs 17.65%,P<0.05).Conclusion MZR is shown an effectiveness and safety in the treatment of children with HSPN.The clinical effect of PDN combined with MZR in the treatment of HSPN is higher than MZR monotherapy.And the long-term prognosis is better than MZR monotherapy.