| 摘要: |
| 目的比较分析激素联合霉酚酸酯（MMF）与环磷酰胺（CTX）治疗Ⅱ、Ⅲ级紫癜性肾炎（HSPN）患儿的临床疗效。方法选取经肾穿刺肾脏病理活检确诊为Ⅱ或Ⅲ级的接受激素联合免疫抑制剂治疗的HSPN患儿45例，按照治疗措施分为MMF组15例和CTX组30例。记录治疗前及治疗后1、3、6、9、12个月尿常规、24h尿蛋白定量、血清白蛋白、血清肌酐、血尿素氮等指标，观察临床表现变化，记录两组治疗期间出现的药物不良反应。结果治疗3、6、9个月时MMF组24h尿蛋白定量均明显低于CTX组，差异均有统计学意义（均P＜0.05）。MMF组治疗1、3个月尿蛋白转阴比例分别为46.7%（7/15）和86.7%（13/15），高于CTX组的16.7%（5/30）和56.7%（17/30），差异均有统计学意义（均P＜0.05）。治疗3、6个月时MMF组血尿缓解率分别为60.0％（9/15）和73.3％（11/15），明显高于CTX组的23.3％（7/30）和40.0％（12/30），差异均有统计学意义（均P＜0.05）。治疗3个月时MMF组血清白蛋白明显高于CTX组，差异有统计学意义（P＜0.05）。两组患儿治疗1、3、6、9、12个月时总缓解率比较差异均无统计学意义（均P＞0.05）；但治疗6、9个月时MMF组完全缓解率均明显高于CTX组，差异均有统计学意义（均P＜0.05）。MMF组出现胃肠道反应及上呼吸道感染各1例；CTX组出现胃肠道反应4例，上呼吸道感染1例，白细胞下降、肝损害、脱发各3例。结论激素联合MMF治疗Ⅱ、Ⅲ级HSPN患儿的近期疗效优于CTX，能更快速地缓解血尿、降低蛋白尿、升高血清白蛋白，达到临床完全缓解，且胃肠道反应、骨髓抑制及肝损害等常见不良反应发生率低，安全性较高。 |
| 关键词: 霉酚酸酯 环磷酰胺 紫癜性肾炎 治疗 儿童 |
| DOI：10.12056/j.issn.1006-2785.2017.39.21.2017-1607 |
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| Comparison of mycophenolate mofetil and cyclophosphamide in treatment of patients with grade II / III Henoch-Schonlein purpura nephritis |
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the Second Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To compare the clinical efficacy of mycophenolate mofetil (MMF) and pulse cyclophosphamide (CTX) therapy combined with prednisolone in treatment of grade II/III Henoch-Scho nlein purpura nephritis (HSPN) in children. Methods Forty-five children with grade II/III HSPN admitted from January 2010 to June 2015 were enrolled in the study. Among 45 patients, 15 were treated with mycophenolate mofetil (MMF group) and 30 were treated with pulse cyclophosphamide (CTX group), predinisolone was simultaneously given to both groups. Clinical assessment was performed, and urine routine, 24h urinary protein, serum albumin, serum creatinine, blood urea nitrogen were measured before and 1, 3, 6, 9 and 12 months after
treatment. The clinical efficacy and side effects were compared between the two groups. Results The amount of 24h urinary protein was much lower in MMF group than that of CTX group at 3, 6 and 9 months after treatment (all P＜0.05), the negative conversion rate of proteinuria in MMF group were higher than that in CTX group (46.7% vs 16.7%, P＜0.05, 86.7% vs 56.7%, P＜
0.01) at 1 and 3 months after treatment. The complete remission rate of urinary RBC count (＜100/滋l) in MMF group was higher
than that in CTX group at 3 and 6 months after treatment (60.0％ vs 23.3％ , 73.3％ vs 40.0％ , both P ＜0.05). There was no significant difference in the total remission rate (complete remission and partial remission) between MMF and CTX(P ＞0.05). The complete remission rate in 6 and 9 month after treatment in MMF group was significantly higher than that in CTX group (both P＜ 0.05). In MMF group there was one case of gastrointestinal reaction and one case of upper respiratory tract infection. In CTX group there were 4 cases of gastrointestinal reaction, 1 case of upper respiratory tract infection, and 3 cases of leukocytopenia, mild liver function damage and alopecia. Conclusion The combination therapy of MMF with steroid is more effective than CTX pulse therapy for patients with grade II /III HSPN in the short term. |
| Key words: Mycophenolate mofetil Cyclophosphamide Henoch-Schonlein purpura nephritis Treatment Children |
