不同年龄段过敏性紫癜性肾炎患儿接受霉酚酸酯或环磷酰胺治疗的疗效差异分析

Therapeutic effect of mycophenolate mofetil or cyclophosphamide in children with Henoch-Schönlein purpura nephritis of different age groups

目的探讨不同年龄段过敏性紫癜性肾炎(Henoch-Schönlein purpura nephritis,HSPN)患儿接受霉酚酸酯(mycophenolate mofetil,MMF)或环磷酰胺(cyclophosphamide,CTX)治疗的效果差异。方法回顾性分析2018年10月—2020年10月首都儿科研究所附属儿童医院肾脏内科收治的接受MMF或CTX治疗的135例HSPN患儿的临床资料。按免疫抑制剂分为MMF组及CTX组,再根据年龄分层为≤12岁亚组和>12岁亚组,即≤12岁MMF亚组30例,>12岁MMF亚组15例,≤12岁CTX亚组71例,>12岁CTX亚组19例。随访至少12个月,比较各组临床疗效及不良反应发生情况。结果MMF组与CTX组治疗3、6、12个月的完全缓解率比较差异无统计学意义(P>0.05)。>12岁MMF亚组和≤12岁MMF亚组治疗3、6、12个月的完全缓解率及不良反应发生率比较,差异无统计学意义(P>0.05)。>12岁CTX亚组治疗6、12个月的完全缓解率低于≤12岁CTX亚组(P<0.05)。>12岁CTX亚组不良反应发生率高于>12岁MMF亚组(P<0.05)。结论MMF疗效及不良反应与年龄无关,但CTX的疗效受年龄影响且不良反应发生率较高,对于>12岁的HSPN患儿应慎重选择CTX。

Objective To investigate the difference in the therapeutic effect of mycophenolate mofetil(MMF)or cyclophosphamide(CTX)in children with Henoch-Schönlein purpura nephritis(HSPN)of different age groups.Methods A retrospective analysis was conducted on the clinical data of 135 children with HSPN who were treated with MMF or CTX in the Department of Nephrology,Children's Hospital Affiliated to Capital Institute of Pediatrics,from October 2018 to October 2020.According to the immunosuppressant used,they were divided into two groups:MMF group and CTX group,and according to the age,each group was further divided into two subgroups:≤12 years and>12 years,producing four groups,i.e,the≤12 years MMF subgroup(n=30),the>12 years MMF subgroup(n=15),the≤12 years CTX subgroup(n=71),and the>12 years CTX subgroup(n=19).All children were followed up for at least 12 months,and the above groups were compared in terms of clinical outcomes and the incidence rate of adverse reactions.Results There was no significant difference in the complete response rate between the MMF group and the CTX group after 3,6,and 12 months of treatment(P>0.05).There were no significant difference in the complete response rate and the incidence rate of adverse reactions between the>12 years MMF subgroup and the≤12 years MMF subgroup at 3,6,and 12 months of treatment(P>0.05).The>12 years CTX subgroup had a significantly lower complete response rate than the≤12 years CTX subgroup at 6 and 12 months of treatment(P<0.05).The>12 years CTX subgroup had a significantly higher incidence rate of adverse reactions than the>12 years MMF subgroup(P<0.05).Conclusions The efficacy and adverse reactions of MMF are not associated with age,but the efficacy of CTX is affected by age,with a higher incidence rate of adverse reactions.CTX should be selected with caution for children with HSPN aged>12 years.