糖皮质激素联合他克莫司治疗难治性肾病综合征的效果观察

Observation of therapeutic effect of glucocorticoid combined with tacrolimus on refractory nephrotic syndrome

目的分析糖皮质激素联合他克莫司治疗难治性肾病综合征(RNS)的临床效果。方法抽取2020年12月至2022年6月苏州大学附属常熟医院收治的RNS患者90例,依据用药方案分为对照组和观察组,每组45例。对照组给予环磷酰胺联合糖皮质激素治疗,观察组给予他克莫司联合糖皮质激素治疗。比较两组肾功能指标、T淋巴细胞亚群、细胞因子及不良反应发生情况。结果治疗后,观察组24 h尿蛋白定量、血肌酐、尿素氮、中性粒细胞明胶酶相关载脂蛋白低于对照组(P<0.05);观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05);观察组白细胞介素-2、白细胞介素-6、白细胞介素-17、肿瘤坏死因子-α水平低于对照组(P<0.05)。两组治疗期间不良反应发生率比较差异未见统计学意义(P>0.05)。结论糖皮质激素联合他克莫司治疗RNS对肾功能改善效果显著,可有效发挥免疫抑制作用,减轻免疫炎性损伤。

ObjectiveTo analyze the therapeutic effect of glucocorticoid combined with tacrolimus on refractory nephrotic syndrome(RNS).MethodsA total of 90 RNS patients admitted to Changshu Hospital Affiliated to Soochow University from December 2020 to June 2022 were selected,and the patients were divided into control group and observation group according to the medication regimen,with 45 cases in each group.The control group was treated with cyclophosphamide combined with glucocorticoids,and the observation group was treated with tacrolimus combined with glucocorticoids.The renal function indicators,T lymphocyte subpopulations,cytokines and incidence of adverse reactions were compared between the two groups.ResultsAfter treatment,the 24-hour urine protein quantification,serum creatinine,urea nitrogen,and neutrophil gelatinase-related apolipoprotein of the observation group were lower than those of the control group(P<0.05);the cluster of differentiation 3^(+)(CD3^(+)),cluster of differentiation 4^(+)(CD4^(+)),and CD4^(+)/cluster of differentiation 8^(+)(CD8^(+))of the observation group were higher than those of the control group,and the CD8^(+)of the observation group was lower than that of the control group(P<0.05).The levels of interleukin-2,interleukin-6,interleukin-17,and tumor necrosis factor-αin the observation group were lower than those in the control group(P<0.05).There was no significant difference in incidence of adverse reactions during treatment between the two groups(P>0.05).ConclusionsGlucocorticoid combined with tacrolimus in the treatment of RNS has a significant effect on improving renal function,and it can effectively exert an immunosuppressive effect and reduce immune inflammatory damage.