强化免疫抑制方案治疗难治性肾病综合征的临床观察 点击下载
| 论文标题： | 强化免疫抑制方案治疗难治性肾病综合征的临床观察 |
| 英文标题： | |
| 中文摘要： | 目的：观察强化免疫抑制方案治疗难治性肾病综合征（RNS）的临床效果及安全性。方法：选取笔者所在2家医院2012年1月－2015年3月收治的RNS患者76例，采用随机数字表法分为对照组和观察组，各38例。两组患者均给予醋酸泼尼松片50 mg，qd；待尿蛋白恢复至正常后减量至15 mg，qd维持。在此基础上，对照组患者给予来氟米特片50 mg，qd；3 d后减量至20 mg，qd维持。观察组患者在对照组基础上加用吗替麦考酚酯分散片750 mg，bid；3个月后减量至500 mg，qd维持。两组患者均治疗6个月。比较两组患者的临床疗效、随访复发率、治疗前后的肾功能指标和炎症细胞因子指标，以及不良反应发生情况。结果：观察组患者的总有效率（92.11％）显著高于对照组（73.68％），随访复发率（5.26％）显著低于对照组（23.68％），差异均有统计学意义（P＜0.05）。治疗前，两组患者的肾功能指标和炎症细胞因子指标比较，差异均无统计学意义（P＞0.05）；治疗后，两组患者的24 h尿蛋白定量、尿白细胞介素6（IL-6）和IL-8水平均较治疗前显著降低，血清白蛋白含量较治疗前显著升高，且观察组指标水平显著优于对照组，差异均有统计学意义（P＜0.05）；两组患者治疗前后血肌酐含量比较，差异均无统计学意义（P＞0.05）。对照组和观察组患者的不良反应发生率分别为34.21％和44.74％，组间比较差异无统计学意义（P＞0.05）。结论：强化免疫抑制方案治疗RNS可有效改善患者肾功能，降低炎症反应水平和远期复发风险，临床疗效较好且安全性较高。 |
| 英文摘要： | OBJECTIVE： To observe the clinical efficacy and safety of enhanced immunosuppressive therapy in the treatment of refractory nephrotic syndrome （RNS）. METHODS： Totally 76 RNS patients were selected from 2 hospitals during Jan. 2012-Mar. 2015， and then divided into control group and observation group according to random number table， with 38 cases in each group. Two groups were given Prednisone acetate tablet 50 mg， qd； decreasing to 15 mg， qd， after urine protein returned to normal. Based on it， control group was given Leflunomide tablets 50 mg， qd； decreasing to 20 mg， qd， 3 days later. Based on control group， observation group was additionally given Mycophenolate mofetil dispersible tablet 750 mg， bid； decreasing to 500 mg， qd， 3 months later. Both groups were treated for 6 months. Clinical efficacies， follow-up recurrence rate as well as renal function indexes and inflammatory cell factors before and after treatment， and the occurrence of ADR were compared between 2 groups. RESULTS： The total response rate of observation group （92.11％） was significantly higher than control group （73.68％）， and follow-up recurrence rate （5.26％） was significantly lower than control group （23.68％）， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in renal function indexes or inflammatory cell factors between 2 groups （P＞0.05）. After treatment， 24 h urinary protein quantification， urinary IL-6 and IL-8 levels of 2 groups decreased significantly， while the content of serum protein increased significantly； the observation group was significantly better than the control group， with statistical significance （P＜0.05）. There was no statistical significance in the content of serum creatinine between 2 groups before and after treatment （P＞0.05）. The incidence of ADR in the control group and the observation group was 34.21％ and 44.74％ respectively， without statistical significance between 2 groups （P＞0.05）. CONCLUSIONS： Enhanced immunosuppressive therapy in the treatment of RNS can improve renal function， reduce inflammatory reaction and long-term recurrence risk， and have good therapeutic efficacy and safety. |
| 期刊： | 2017年第28卷第23期 |
| 作者： | 史添立，罗贞，焦石 |
| 英文作者： | SHI Tianli，LUO Zhen，JIAO Shi |
| 关键字： | 强化免疫抑制方案；免疫抑制剂；难治性肾病综合征；糖皮质激素；来氟米特；吗替麦考酚酯；肾功能；复发风险；药品不良反应 |
| KEYWORDS： | Enhanced immunosuppressive therapy； Immunosuppressive agent； Refractory nephrotic syndrome； Glucocorticoids； Leflunomide； Mycophenolate mofetil； Renal function； Recurrence risk； ADR |
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