利妥昔单抗与环磷酰胺联合醋酸泼尼松治疗儿童难治性肾病综合征的效果比较

Comparison of effects of Rituximab and Cyclophosphamide combined with Prednisone acetate in treatment of refractory nephrotic syndrome in children

目的:比较利妥昔单抗与环磷酰胺联合醋酸泼尼松治疗儿童难治性肾病综合征(RNS)的效果。方法:选取2021年11月至2022年11月该院收治的60例RNS患儿进行前瞻性研究,按照随机数字表法将其分为研究组和对照组各30例。两组均口服醋酸泼尼松片治疗,在此基础上,对照组联合注射用环磷酰胺治疗,研究组联合利妥昔单抗注射液治疗。比较两组临床疗效,治疗前后肾功能指标[血尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白定量(24hUP)]水平、血脂指标[低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)]水平,不良反应发生率及复发率。结果:研究组治疗总有效率93.33%(28/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05);治疗后,研究组BUN、Scr、24hUP、LDL-C、TG、TC水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);随访1年后,研究组复发率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论:利妥昔单抗联合醋酸泼尼松治疗儿童RNS效果确切,可改善肾功能,降低血脂水平及复发率,效果优于环磷酰胺联合醋酸泼尼松治疗。

Objective:To compare effects of Rituximab and Cyclophosphamide combined with Prednisone acetate in treatment of refractory nephrotic syndrome(RNS)in children.Methods:A prospective study was conducted on 60 children with RNS admitted to this hospital from November 2021 to November 2022.According to the random number table method,they were divided into study group and control group,30 cases in each group.Both groups were treated with oral Prednisone acetate tablets.On this basis,the control group was treated with Cyclophosphamide for injection,while the study group was treated with Rituximab injection.The clinical efficacy,the renal function indexes[blood urea nitrogen(BUN),serum creatinine(Scr),24 h urinary protein quantification(24hUP)]levels,the blood lipid indexes[low-density lipoprotein cholesterol(LDL-C),triacylglycerol(TG),total cholesterol(TC)]levels before and after the treatment,and the incidence of adverse reactions and recurrence rate were compared between the two groups.Results:The total effective rate of the study group was 93.33%(28/30),which was higher than 73.33%(22/30)of the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of BUN,Scr,24hUP,LDL-C,TG and TC in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).After 1 year of follow-up,the recurrence rate of the study group was 6.67%,which was lower than 26.67%of the control group,and the difference was statistically significant.Conclusions:Rituximab combined with Prednisone acetate is effective in the treatment of RNS in the children,which can improve the renal function and reduce the blood lipid levels and the recurrence rate.Moreover,it is superior to Cyclophosphamide combined with Prednisone acetate treatment.