他克莫司与环磷酰胺联合糖皮质激素治疗儿童难治性肾病综合征的疗效

Comparison of efficacy of tacrolimus versus cyclophosphamide in combination with glucocorticoids in the treatment of refractory nephrotic syndrome in children

目的:探讨他克莫司与环磷酰胺联合糖皮质激素治疗儿童难治性肾病综合征(RNS)的疗效。方法:回顾性分析在某医院治疗的57例难治性肾病综合征患儿病例资料,根据治疗方式的不同分为他克莫司组与环磷酰胺组。比较两组24 h尿蛋白定量、血浆白蛋白、血肌酐、血总胆固醇、CD4+淋巴细胞百分比、CD8+淋巴细胞百分比、CD4^(+)/CD8^(+)比值、补体C3、免疫球蛋白Ig G、治疗后转归及不良反应发生情况。结果:两组治疗前后,24 h尿蛋白定量、血Ig G及补体C3指标相近(P>0.05);两组治疗前后,白蛋白、肌酐、总胆固醇等三项指标水平均相近(P>0.05);治疗后,他克莫司组CD4^(+)、CD4^(+)/CD8^(+)水平均高于环磷酰胺组,CD8^(+)水平低于环磷酰胺组(P<0.05);治疗6个月后他克莫司组总缓解率高于环磷酰胺组,但差异无统计学意义(P>0.05);他克莫司组不良反应总发生率低于环磷酰胺组(P<0.05)。结论:他克莫司与环磷酰胺治疗RNS患儿的总缓解率相当,但他克莫司对机体免疫功能影响较小,不良反应发生率较低。

Objective:To compare the tacrolimus joint glucocorticoid and cyclophosphamide treatment of refractory nephrotic syndrome in children(Refractory nephrotic syndrome,RNS)curative effect.Methods:Retrospective analysis was performed on 57 children with refractory nephrotic syndrome treated in a hospital,and they were divided into tacrolimus group and cyclophosphamide group according to different treatment methods.24-hour urinary protein quantity,plasma albumin,serum creatinine,total cholesterol,percentage of CD4*lymphocytes,percentage of CD8*lymphocytes,ratio of CD4*/CD8+,complement C3,immunoglobulin IgG,outcome after treatment and occurrence of adverse reactions were compared between the two groups.Results:Before and after treatment,24 h urinary protein quantity,blood IgG and complement C3 indexes were similar in the two groups(P>0.05).The levels of albumin,creatinine and total cholesterol were similar in two groups before and after treatment(P>0.05).After treatment,CD4+and CD4*/CD8+levels in tacrolimus group were higher than those in cyclophosphamide group,while CD8*levels were lower than those in cyclophosphamide group(P<0.05).After 6 months of treatment,the total remission rate in tacrolimus group was higher than that in cyclophosphamide group,but the difference was not statistically significant(P>0.05).The overall incidence of adverse reactions in tacrolimus group was lower than that in cyclophosphamide group(P<0.05).Conclusion:The overall response rate of tacrolimus was comparable to that of cyclophosphamide in children with RNS,but tacrolimus had less effect on immune function and a lower incidence of adverse reactions.