霉酚酸酯与环孢素A分别联合泼尼松治疗原发性难治性肾病综合征的效果比较

Therapeutic effect of mycophenolate mofetil and cyclosporine A in combination with prednisone on idiopathic refractory nephrotic syndrome

目的比较霉酚酸酯、环孢素A分别联合泼尼松治疗原发性难治性肾病综合征的临床效果。方法抽取2021年1月至2023年1月驻马店市中心医院收治的原发性难治性肾病综合征患者76例,将其随机分为研究组和常规组,每组38例。常规组予以霉酚酸酯联合泼尼松治疗,研究组予以环孢素A联合泼尼松治疗。对比两组疗效、肾功能[尿蛋白(Pa)、血肌酐(Scr)、尿酸(UA)、尿素(BUN)]水平、尿液肾损伤分子1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平、免疫功能[分化簇4(CD4^(+))、分化簇8(CD8^(+))]水平、血小板活化因子水解酶(PAF-AH)水平、血小板活化因子(PAF)水平及不良反应发生率。结果研究组治疗总有效率(94.74%,36/38)高于常规组(76.32%,29/38),P<0.05;治疗后,研究组Pa、Scr、UA、BUN水平低于常规组(P<0.05);治疗后,研究组KIM-1、NGAL水平低于常规组(P<0.05);治疗后,研究组CD4^(+)水平低于常规组(P<0.05),两组CD8^(+)水平比较差异未见统计学意义(P>0.05);治疗后,研究组PAF-AH水平高于常规组,PAF水平低于常规组(P<0.05);两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论与霉酚酸酯联合泼尼松治疗相比,环孢素A联合泼尼松治疗原发性难治性肾病综合征患者可提高临床疗效,能降低KIM-1、NGAL水平,调节T淋巴细胞亚群及PAF-AH、PAF水平,可显著改善肾功能,且具有安全性。

Objective To analyze the idiopathic effect of mycophenolate mofetil and cyclosporine A in combination with prednisone on idiopathic refractory nephrotic syndrome.Methods A total of 76 patients with idiopathic refractory nephrotic syndrome treated in Zhumadian Central Hospital from January 2021 to January 2023 were selected,and they were randomly divided into study group and conventional group,with 38 cases in each group.The conventional group was treated with mycophenolate mofetil combined with prednisone,and the study group was treated with cyclosporine A combined with prednisone.The therapeutic effect,renal function,which was assessed by urinary protein(Pa),blood creatinine(Scr),uric acid(UA)and blood urea nitrogen(BUN),the levels of urinary renal injury molecule 1(KIM-1),level of neutrophil gelatinase-associated lipocalin(NGAL),immune function assessed by cluster of differentiation 4^(+)(CD4^(+))and cluster of differentiation 8^(+)(CD8^(+)),level of platelet activating factor hydrolase(PAF-AH),levels of platelet activating factor(PAF),and the incidence of adverse reactions were compared between the two groups.Results The total effective rate of the study group was 94.74%(36/38),which was higher than the 76.32%(29/38)of the conventional group(P<0.05).After treatment,the levels of Pa,Scr,UA,and BUN in the study group were lower than those in the conventional group(P<0.05).After treatment,the levels of KIM-1 and NGAL in the study group were lower than those in the conventional group(P<0.05).After treatment,the CD4^(+)level in the study group was lower than that in the conventional group(P<0.05),while there was no significant difference in CD8^(+)level between the two groups(P>0.05).After treatment,the level of PAF-AH in the study group was higher than that in the conventional group,while the level of PAF was lower than that in the conventional group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Compared with mycophenolate mofetil combined with prednisone,the combination therapy of cyclosporine A with prednisone for idiopathic refractory nephrotic syndrome can improve the clinical efficacy,decrease the levels of KIM-1 and NGAL,regulate the levels of T lymphocyte subsets,PAF-AH and PAF.Moreover,it can significantly improve renal function,with safety.