早期、足量应用激素联合吗替麦考酚酯对增殖性狼疮性肾炎患者疗效及预后的影响
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摘要
目的分析早期、足量应用激素联合吗替麦考酚酯对增殖性狼疮性肾炎患者的疗效及预后的影响。方法选取重庆市开州区人民医院内科2016年4月～2017年10月收治的92例增殖性狼疮性肾炎患者,按随机数字表法将其分为两组,每组各46例。对照组早期应用足量激素和环磷酸酰胺治疗,观察组早期应用足量激素联合吗替麦考酚酯治疗,比较两组临床疗效。结果与对照组比较,观察组治疗总有效率明显升高(P <0.05),治疗后的尿素氮、血肌酐水平及24 h尿蛋白定量结果与对照组比较,差异有统计学意义(P <0.05)。观察组不良反应总发生率明显低于对照组(P <0.05)。经1年随访,观察组患者的肾脏病复发率明显低于对照组(P <0.05)。结论早期、足量应用激素联合吗替麦考酚酯对增殖性狼疮性肾炎有显著疗效,可改善患者肾功能,降低肾脏病复发风险,且药物安全性较高。
Objective To analyze the effect of early and sufficient application of hormone combined with mortethaphenolate on the efficacy and prognosis of patients with proliferative lupus nephritis. Methods From April 2016 to October2017, 92 patients with proliferative lupus nephritis admitted and treated in the Department of Internal Medicine of the People′ s Hospital of Kaizhou District Chongqing were selected and divided into two groups according to the random number table method, 46 patients in each group. The control group was treated with adequate Hormone and Cyclophosphamide at the early stage, and the observation group was treated with adequate Hormone combined with Motimecophenolate at the early stage, and the clinical effects of the two groups were compared. Results Compared with the control group, the total effective rate was significantly increased in the observation group(P < 0.05), and the results of urea nitrogen, serum creatinine level and 24 h urine protein quantification after treatment were lower than the control group,with statistically significant differences(P < 0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P < 0.05). After 1 year follow-up, the recurrence rate of renal disease in the observation group was significantly lower than that in the control group(P < 0.05). Conclusion Early and sufficient application of Hormone combined with Morteofloxacin has a significant effect on proliferative lupus nephritis,which can improve the renal function of patients, reduce the risk of renal recurrence, and the drug safety is relatively high.
Objective To analyze the effect of early and sufficient application of hormone combined with mortethaphenolate on the efficacy and prognosis of patients with proliferative lupus nephritis. Methods From April 2016 to October2017, 92 patients with proliferative lupus nephritis admitted and treated in the Department of Internal Medicine of the People′ s Hospital of Kaizhou District Chongqing were selected and divided into two groups according to the random number table method, 46 patients in each group. The control group was treated with adequate Hormone and Cyclophosphamide at the early stage, and the observation group was treated with adequate Hormone combined with Motimecophenolate at the early stage, and the clinical effects of the two groups were compared. Results Compared with the control group, the total effective rate was significantly increased in the observation group(P < 0.05), and the results of urea nitrogen, serum creatinine level and 24 h urine protein quantification after treatment were lower than the control group,with statistically significant differences(P < 0.05). The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P < 0.05). After 1 year follow-up, the recurrence rate of renal disease in the observation group was significantly lower than that in the control group(P < 0.05). Conclusion Early and sufficient application of Hormone combined with Morteofloxacin has a significant effect on proliferative lupus nephritis,which can improve the renal function of patients, reduce the risk of renal recurrence, and the drug safety is relatively high.
引文
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[2]刘洋,刘正钊,周敏林,等.伴抗磷脂综合征狼疮性肾炎患者的临床特点及预后[J].肾脏病与透析肾移植杂志,2017,26(2):125-130.
[3]赵筱娟,李红莉,周淑娟.Ⅳ型狼疮性肾炎不同病理亚型的临床、病理及预后分析[J].西南国防医药,2016,26(10):1113-1115.
[4]董洋,阎磊,李纳,等.不同免疫抑制剂联合糖皮质激素治疗特发性膜性肾病的临床疗效比较[J].中华实用诊断与治疗杂志,2017,31(10):1017-1019.
[5]胡昭,李垟.吗替麦考酚酯在肾脏疾病中的合理应用[J].中华肾病研究电子杂志,2014,3(4):16-20.
[6]王海燕.肾脏病学[M].3版.北京:人民卫生出版社,2008:936-938.
[7]中华医学会儿科学分会肾脏学组.狼疮性肾炎诊治循证指南(2016)解读[J].2018,56(2):88-94.
[8]陈卫红,曹斌.健脾祛湿中药联合激素冲击疗法治疗复发性肾病综合征疗效及对炎性细胞因子、纤溶指标的影响[J].现代中西医结合杂志,2017,26(35):3929-3932.
[9]熊金河,张海英.来氟米特对育龄期女性狼疮性肾炎维持治疗的影响[J].西部医学,2014,26(12):1641-1642.
[10]麦地努尔·阿不力米提.狼疮性肾炎患者预后影响因素分析[D].乌鲁木齐:新疆医科大学,2017.
[11]赵筱娟,李红莉,周淑娟.Ⅳ型狼疮性肾炎不同病理亚型的临床、病理及预后分析[J].西南国防医药,2016,26(10):1113-1115.
[12]柯丽莉.匹多莫德联合小剂量甲泼尼龙对难治性肺炎支原体肺炎患儿免疫功能及血清炎性细胞因子水平的影响[J].山西医药杂志,2017,46(19):2340-2342.
[13]田增英.静脉滴注环磷腺苷葡胺致严重神经、心脏不良反应1例[J].中国药物经济学,2014,25(11):59-60.
[14]解博.大剂量甲基强的松龙冲击治疗神经系统免疫性疾病不良反应观察[J].长春:吉林大学,2016.
[15]杨有国,韦夙,李小芬,等.老年性狼疮性肾炎患者采用免疫抑制剂治疗的临床效果观察[J].临床和实验医学杂志,2017,16(10):997-1000.
[16]徐怡.吗替麦考酚酯的药代动力学及其临床应用研究进展[J].北方药学,2017,14(2):133-134.
[17]袁恒杰.吗替麦考酚酯临床应用新进展[J].天津药学,2012,24(4):62-65.
[18]张洲,杜悦.吗替麦考酚酯在儿童肾脏疾病中的应用[J].国际儿科学杂志,2016,43(12):76-77.
[19]漆媛媛.肾脏复发的Ⅳ型狼疮性肾炎:临床、预后特征及临床风险因素分析[D].兰州:兰州大学,2015.
[20]戚超君,叶彬娴,倪兆慧,等.增殖型和膜型狼疮性肾炎患者缓解及复发的相关因素四年随访研究[J].中华医学杂志,2013,93(48):3826-3830.
[21]李雅楠,刘永恒,李玥,等.综合护理干预对狼疮性肾炎儿童自我效能感的影响效果分析[J].中国现代医生,2018,56(9):159-161.