他克莫司联合激素对激素耐药难治性肾病综合征患儿调节性T细胞的影响及其临床疗效研究

Influence and Clinical Effect Research of Tacrolimus Combined with Hormone on Regulatory T Cells of Children with Hormone Resistant Refractory Nephrotic Syndrome

目的 探究激素耐药难治性肾病综合征患儿应用他克莫司联合激素治疗的效果。方法 将本院2021年7月-2022年6月收治的54例激素耐药难治性肾病综合征患儿随机分为研究组和对照组(n=27),均采取糖皮质激素治疗,研究组采取他克莫司治疗,对照组采取环磷酰胺治疗,观察并比较两组患儿的并发症、调节性T细胞(Treg),冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)等肝功能指标,血肌酐、尿素氮、24小时尿蛋白定量等肾功能指标,N-乙酰-β-D葡萄糖苷酶(NAG)、肾损伤分子-1(KIM-1)、视黄醇结合蛋白(RBP)等尿肾损伤标志物,以及空腹血糖、甘油三酯、总胆固醇等糖脂代谢指标。结果 研究组的并发症总发生率显著低于对照组(P<0.05);治疗后,研究组的Treg水平显著高于对照组(P<0.05);治疗后,研究组的AST、ALT水平与对照组差异小(P>0.05);治疗后,研究组的血肌酐、尿素氮、24小时尿蛋白定量水平显著低于对照组(P<0.05);治疗后,研究组的NAG、KIM-1、RBP水平显著低于对照组(P<0.05);治疗后,研究组的空腹血糖水平与对照组差异小(P>0.05),甘油三酯、总胆固醇水平显著低于对照组(P<0.05)。结论 在对激素耐药难治性肾病综合征患儿的治疗中,他克莫司与激素联合治疗,在不影响肝功能的同时,可提高Treg水平,优化脂代谢,改善肾功能,安全性较高,治疗效果显著。

Objective To explore effect of tacrolimus combined with hormone therapy for children with hormone resistant refractory nephrotic syndrome.Methods The paper chose 54 children with hormone resistant refractory nephrotic syndrome admitted to our hospital from July 2021 to June 2022,and divided them into study group and control group(n=27)randomly,with glucocorticoid treatment.Study group was treated with tacrolimus treatment,while control group with cyclophosphamide treatment.Complications,liver function indicators of regulatory T cells(Treg),aspartate aminotransferase(AST)and alanine aminotransferase(ALT),renal function indicators of serum creatinine,urea nitrogen,24-hour urine protein quantification,and markers of urinary and renal injury of N-acetyl-β-D-glucosidase(NAG),renal injury molecule-1(KIM-1),retinol binding protein(RBP),glucose and lipid metabolism indicators of fasting blood glucose,triglycerides,total cholesterol were observed and compared.Results Total complications incidence in study group was significantly lower than control group(P<0.05).After treatment,Treg level in study group was significantly higher than control group(P<0.05).After treatment,AST and ALT levels in study group had little difference against control group(P>0.05).After treatment,levels of serum creatinine,urea nitrogen,and 24-hour urinary protein in study group were significantly lower than control group(P<0.05).After treatment,the levels of NAG,KIM-1,and RBP in study group were significantly lower than control group(P<0.05).After treatment,fasting blood glucose level in study group was slightly lower than control group(P>0.05),levels of triglycerides and total cholesterol were significantly lower than control group (P<0.05). Conclusion In treatment of children with steroid-resistant refractory nephrotic syndrome,tacrolimus combined with hormones can increase Treg levels, optimize lipid metabolism, improve renalfunction with high safety and significant curative effect without affecting liver function.