他克莫司与环磷酰胺分别联合甲泼尼龙治疗狼疮性肾炎患者的效果比较

Comparison of effects of Tacrolimus combined with methylprednisolone and cyclophosphamide combined with methylprednisolone in treatment of patients with lupus nephritis

目的:比较他克莫司与环磷酰胺分别联合甲泼尼龙治疗狼疮性肾炎患者的效果。方法:选取2018年10月至2021年2月该院收治的105例狼疮性肾炎患者进行前瞻性研究,按照随机数字表法分为观察组53例和对照组52例。两组均采用常规治疗,在此基础上,对照组采用环磷酰胺联合甲泼尼龙治疗,观察组采用他克莫司联合甲泼尼龙治疗。治疗6个月后,比较两组治疗效果,治疗前后T细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+))水平、肾功能指标(血肌酐、血尿素氮、胱抑素C、24 h尿蛋白定量)水平,以及不良反应发生率。结果:观察组治疗总有效率为88.68%,高于对照组的69.23%,差异有统计学意义(P<0.05);治疗后,两组CD3^(+)、CD4^(+)水平均高于治疗前,且观察组高于对照组,两组CD8^(+)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组血肌酐、血尿素氮、胱抑素C水平和24 h尿蛋白定量均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为3.77%,低于对照组的17.31%,差异有统计学意义(P<0.05)。结论:他克莫司联合甲泼尼龙治疗狼疮性肾炎患者可提高治疗总有效率,改善T细胞亚群指标和肾功能指标水平,效果优于环磷酰胺联合甲泼尼龙治疗。

Objective:To compare effects of Tacrolimus combined with methylprednisolone and cyclophosphamide combined with methylprednisolone in treatment of patients with lupus nephritis.Methods:A prospective study was performed on 105 patients with lupus nephritis admitted to this hospital from October 2018 to February 2021,and they were divided into observation group(53 cases)and control group(52 cases)according to the random number table method.Both groups received conventional treatment.On this basis,the control group was treated with Cyclophosphamide combined with Methylprednisolone,while the observation group was treated with Tacrolimus combined with Methylprednisolone.The two groups were treated for 6 months.The treatment effects,the levels of T cell subsets(CD3^(+),CD4^(+),CD8^(+)),the levels of renal function indexes(serum creatinine,blood urea nitrogen,cystatin C,24-hour urine protein quantification),and the incidence of adverse reactions were compared between the two groups before and after the treatment.Results:The total effective rate of the observation group was 88.68%,which was higher than 69.23%of the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of CD3^(+)and CD4^(+)in the two groups were higher than those before the treatment,and those of the observation group were higher than those of the control group;the levels of CD8^(+)in the two groups were lower than those before the treatment,and that in the observation group was lower than that in the control group;and the differences were statistically significant(P<0.05).After the treatment,the levels of serum creatinine,blood urea nitrogen,cystatin C,and 24-hour urine protein in the two groups were lower than those before the treatment,those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in the observation group was 3.77%,which was lower than 17.31%in the control group,and the difference was statistically significant(P<0.05).Conclusions:Tacrolimus combined with Methylprednisolone in the treatment of the patients with lupus nephritis can improve the total effective rate of treatment,and improve the levels of T cell subsets and renal function indexes.Moreover,it is superior to Cyclophosphamide combined with Methylprednisolone.