雷公藤多苷联合他克莫司及激素治疗难治性肾病综合征的效果及对血清sTNF-R1、IGFBP-2、CFH水平的影响

Therapeutic efficacy of tripterygium glycosides combined with tacrolimus and hormone in treatment of refractory nephrotic syndrome and its effects on serum levels of sTNF-R1,IGFBP-2 and CFH

目的 探讨雷公藤多苷联合他克莫司及激素治疗难治性肾病综合征(RNS)的疗效对血清可溶性肿瘤坏死因子受体1(s TNF-R1)、胰岛素样生长因子结合蛋白-2(IGFBP-2)、补体因子H(CFH)水平的影响。方法 研究对象为2018年8月至2021年8月于江南大学附属医院治疗的RNS患者102例,以随机数字表法分为对照组(n=51,采取甲泼尼龙片加他克莫司胶囊治疗)和观察组(n=51,在对照组基础上给予雷公藤多苷片治疗)。评估两组的治疗效果、血清相关指标,统计两组的不良反应。结果 观察组治疗总有效率(96.08%)高于对照组(80.39%)(χ^(2)=6.044,P=0.014);治疗后,观察组患者血清白蛋白、CFH水平[分别为(36.54±8.11) g·L^(-1)、(586.20±100.72)μg·m L^(-1)],高于对照组[分别为(32.58±6.12) g·L^(-1)、(540.11±100.47)μg·m L^(-1)],差异均有统计学意义(t=2.783,P=0.006;t=2.314,P=0.023);观察组患者24 h尿蛋白、肌酐、s TNF-R1、IGFBP-2水平[分别为(2.67±0.69) g、(82.25±16.13)μmol·L^(-1)、(1.56±0.45) ng·m L^(-1)、(51.34±10.44) ng·m L^(-1)],低于对照组[分别为(3.24±1.02) g、(92.68±17.35)μmol·L^(-1)、(1.91±0.58) ng·m L^(-1)、(57.79±12.58) ng·m L^(-1)],差异均有统计学意义(t=3.306,P=0.001;t=3.135,P=0.002;t=3.405,P=0.001;t=2.820,P=0.005);观察组复发率(1.96%)低于对照组(13.73%)(χ^(2)=4.883,P=0.027)。结论 公藤多苷联合他克莫司及激素治疗RNS效果佳,降低复发率,改善肾功能,减轻炎症,有望作为辅助治疗RNS的药物。

Objective To explore the the efficacy of tripterygium glycosides combined with tacrolimus and hormone therapy in treatment of refractory nephrotic syndrome(RNS)and its effects on serum levels of soluble tumor necrosis factor receptor 1(sTNF-R1),insulin-like growth factor binding protein-2(IGFBP-2)and complement factor H(CFH).Methods The research subjects were 102 patients with RNS admitted to the Affiliated Hospital of Jiangnan University from August 2018 to August 2021,and they were divided into the control group(n=51,treated with methylprednisolone tablet and tacrolimus capsule)and the observation group(n=51,treated with tripterygium glycosides tablet based on the regimen in the control group)by the random number table method.The therapeutic effect and serum-related indicators were evaluated and the adverse reactions counted in both groups.Results The total effective rate of treatment in the observation group(94.12%)was higher than that in the control(78.43%)(χ^(2)=5.299,P=0.021).After treatment,the levels of serum albumin and CFH in the observation group were(36.54±8.11)g·L^(-1) and(586.20±100.72)μg·mL^(-1),which were higher than those of(32.58±6.12)g·L^(-1) and(540.11±100.47)μg·mL^(-1) in the control(t=2.783,P=0.006;t=2.314,P=0.023).The levels of 24 h urinary protein,creatinine,sTNF-R1 and IGFBP-2 were(2.67±0.69)g,(82.25±16.13)μmol·L^(-1),(1.56±0.45)ng·mL^(-1) and(51.34±10.44)ng·mL^(-1) in the observation group,which were lower than those of(3.24±1.02)g,(92.68±17.35)μmol·L^(-1),(1.91±0.58)ng·mL^(-1) and(57.79±12.58)ng·mL^(-1) in the control(t=3.306,P=0.001;t=3.135,P=0.002;t=3.405,P=0.001;t=2.820,P=0.005).The recurrence rate in the observation group was 1.96%,which was lower than that of 13.73%in control(χ^(2)=4.883,P=0.027).Conclusion Tripterygium glycosides combined with tacrolimus and hormone has a good therapeutic effect on RNS because it can reduce the recurrence rate,improve the renal function and relieve the inflammation.Therefore,it is expected to be used as adjuvant therapy for RNS.