CTX与MMF对伴蛋白尿过敏性紫癜性肾炎患儿PBMCs内γδT细胞及相关因子水平的影响

Effects of CTX and MMF on the Levels of γδT Cells and Related Factors in PBMCs of Children with Allergic Purpura Nephritis with Proteinuria

目的 探究环磷酰胺(CTX)与霉酚酸酯(MMF)对过敏性紫癜性肾炎患儿伴蛋白尿外周血单个核细胞(PBMCs)内γδT细胞及相关因子水平的影响。方法 回顾性分析2019年2月至2020年12月期间我院收治蛋白尿过敏性紫癜性肾炎患儿共116例,根据治疗方法的不同将患儿分为CTX组(n=62)与MMF组(n=54),CTX组接受环磷酰胺联合激素治疗,MMF组接受霉酚酸酯联合激素治疗,治疗结束后,比较两组患儿临床疗效、γδT细胞抗原受体(γδTCR)、粒酶B以及穿孔素水平;干扰素-γ(IFN-γ)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平以及不良反应发生率。结果 MMF组的治疗总有效率为94.44%,显著高于CTX组的80.64%(P<0.05);两组接受治疗后,γδTCR、粒酶B以及穿孔素相比治疗前均出现显著下降(P<0.05),其中观察组下降更加显著(P<0.05);IFN-γ、IL-10以及TNF-α相比治疗前均出现显著下降(P<0.05),观察组下降更加显著(P<0.05),MMF患者治疗后不良反应发生率显著低于CTX组(P<0.05)。结论 MMF治疗过敏性紫癜性肾炎患儿伴蛋白尿疗效显著,能够有效调节患儿机体免疫功能,促进PBMCs内γδT细胞及相关因子恢复正常水平,安全性高。

Objective To investigate the effects of cyclophosphamide(CTX) and mycophenolate mofetil(MMF) on the levels of γδT cells and related factors in peripheral blood mononuclear cells(PBMCs) in children with allergic purpura nephritis with proteinuria.Methods A total of 116 children with proteinuria allergic purpura nephritis who were treated in our hospital from February 2019 to December 2020 were retrospectively analyzed. According to different treatment methods, the children were divided into CTX group(n=62) and MMF group. Group(n=54), CTX group received cyclophosphamide combined with hormone therapy, MMF group received mycophenolate mofetil combined with hormone therapy, after treatment, the clinical efficacy, γδT cell antigen receptor(γδTCR),granulocyte Enzyme B and perforin levels;interferon-γ(IFN-γ),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)levels, and incidence of adverse reactions.Results The total effective rate of MMF group was 94.44%,which was significantly higher than 80.64% of CTX group(P<0.05),and the observation group decreased more significantly(P<0.05);IFN-γ,IL-10 and TNF-α all decreased significantly compared with those before treatment(P<0.05),and the observation group decreased more significantly(P<0.05).the incidence of adverse reactions in MMF patients after treatment was significantly lower than that in CTX group(P<0.05).Conclusion MMF is effective in the treatment of children with allergic purpura nephritis with proteinuria, which can effectively regulate the immune function of children, and promote the return of γδT cells and related factors in PBMCs to normal levels, with high safety.