环磷酰胺联合激素治疗中高危特发性膜性肾病的临床效果观察

Clinical Effect of Cyclophosphamide Combined with Hormone in the Treatment of Medium and High Risk Idiopathic Membranous Nephropathy

目的:探讨环磷酰胺联合激素治疗中高危特发性膜性肾病(IMN)的临床效果。方法:选取2018年6月—2020年6月期间我院收治的中高危特发性膜性肾病(IMN)60例患者作为研究对象,根据治疗方法不同分为两组。对照组(n=30)给予优化支持治疗,治疗组(n=30)在优化支持治疗的基础上加用环磷酰胺联合激素治疗。所有患者均治疗6个月。比较两组的临床效果,比较治疗前后肾功能指标、血清磷脂酶A2受体抗体(PLA2R-Ab)、血清白蛋白水平及外周血T淋巴细胞亚群。结果:在临床治疗效果方面,治疗组高于对照组(93.33%VS 66.67%),有统计学差异(P<0.05)。两组患者经过治疗后,24h尿蛋白、血Scr水平降低,血清白蛋白水平升高(P<0.05);治疗组治疗后24h尿蛋白低于对照组,血清白蛋白高于对照组(P<0.05)。两组患者治疗后,血清PLA2R-Ab、CD8^(+)降低,CD4^(+)、CD4^(+)/CD8^(+)均升高(P<0.05);治疗后,治疗组患者血清PLA2R-Ab、CD8^(+)低于对照组,CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组(P<0.05)。结论:环磷酰胺联合激素治疗中高危膜性肾病的临床效果显著,患者肾功能及免疫功能改善,推广及应用的临床价值较高。

Objective:To investigate the clinical effect of cyclophosphamide combined with hormone in the treatment of medium and high-risk idiopathic membranous nephropathy(IMN).Method:60 patients with medium and high risk idiopathic membranous nephropathy(IMN)treated in our hospital from June 2018 to June 2020 were selected as the research objects and divided into two groups according to different treatment methods.The control group(n=30)was given optimized support treatment,and the treatment group(n=30)was treated with cyclophosphamide combined with hormone on the basis of optimized support treatment.All patients were treated for 6 months.The clinical effects of the two groups were compared,and the renal function indexes,serum phospholipase A2 receptor antibody(PLA2R-Ab),serum albumin level and peripheral blood T lymphocyte subsets were compared before and after treatment.Result:In terms of clinical treatment effect,the treatment group was higher than the control group(93.33%VS 66.67%)(P<0.05).After treatment,the levels of 24-hour urinary protein and blood SCR decreased,and the level of serum albumin increased(P<0.05);24 hours after treatment,urinary protein in the treatment group was lower than that in the control group,and serum albumin was higher than that in the control group(P<0.05).After treatment,serum PLA2R-Ab and CD8^(+)decreased,CD4^(+)and CD4^(+)/CD8^(+)increased(P<0.05);After treatment,the levels of serum PLA2R-Ab and CD8^(+)in the treatment group were lower than those in the control group,and the levels of CD4^(+)and CD4^(+)/CD8^(+)in the treatment group were higher than those in the control group(P<0.05).Conclusion:The clinical effect of cyclophosphamide combined with hormone in the treatment of medium and high-risk membranous nephropathy is significant,the renal function and immune function of patients are improved,and the clinical value of popularization and application is high.