他克莫司治疗儿童紫癜性肾炎疗效观察

摘要

Objective To evaluate the efficacy and safety of tacrolimus (TAC) for treatment of Henoch-SchSnlein purpura nephritis in children.Methods Forty children with Henoch-SchSnlein purpura nephritis (pathological grade Ⅲ-Ⅵ) in Children's Hospital Affiliated to Soochow University from January 2013 to June 2016 were selected and divided into TAC group (n =19) and cyclophosphamide (CTX) group (n =21).The children in TAC group were given TAC orally;the children in CTX group were given CTX pulse therapy intravenously.The 24 h urine protein,urine red blood cell count,serum albumin,serum creatinine and blood urea nitrogen of children before treatment and after 6 months treatment were observed and compared between the two groups.The treatment effects and adverse reactions of patients were observed and compared between the two groups.Results There was no statistic difference in the 24 h urine protein,urine red blood cells count,serum albumin,blood creatinine and blood urea nitrogen levels of children between the two groups before treatment (P ＞ 0.05).The 24 h urinary protein and urine red blood cells count of children after 6 months of treatment in the two groups were significantly lower than those before treatment (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children in the two groups before treatment and after 6 months of treatment (P ＞ 0.05).Mter 6 months of treatment,the 24 h urine protein and urine red blood cells count of children in TAC group were significantly lower than those in the CTX group (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children between the two groups (P ＞ 0.05).After 6 months treatment,the effective rate of children in the TAC group was significantly higher than that in the CTX group (x2 =4.607,P ＜ 0.05).The incidence of adverse reactions of children in the TAC group was significantly lower than that in the CTX group (x2 =4.043,P ＜ 0.05).Conclusion TAC is effective in treatment of Henoch-Sch(o)nlein purpura nephritis in children.It is easy to take,and has less adverse reactions.%目的 探讨他克莫司(TAC)治疗儿童紫癜性肾炎的疗效和安全性.方法 选择2013年1月至2016年6月于苏州大学附属儿童医院接受治疗且病理分级Ⅲ～Ⅵ级的40例紫癜性肾炎患儿,分为TAC组19例和环磷酰胺(CTX)组21例,TAC组患儿给予TAC口服治疗,CTX组患儿给予静脉CTX冲击治疗,观察比较2组患儿治疗前与治疗6个月后的24 h尿蛋白定量、尿红细胞计数、血清白蛋白、血肌酐、血尿素氮,并观察比较2组患儿的治疗效果及不良反应情况.结果 治疗前2组患儿的24h尿蛋白量、尿红细胞计数、血清白蛋白、血肌酐、血尿素氮水平比较差异均无统计学意义(P＞0.05).治疗6个月后,2组患儿的24h尿蛋白量、尿红细胞计数较治疗前均显著减少(P＜0.05);2组患儿的血清白蛋白有所升高,血肌酐、血尿素氮有所降低,但与治疗前比较差异均无统计学意义(P＞0.05).治疗6个月后,TAC组患儿的24 h尿蛋白量、尿红细胞计数较CTX组显著下降(P＜0.05);2组患儿的血清白蛋白、血肌酐、血尿素氮比较差异均无统计学意义(P＞0.05).治疗6个月后,TAC组患儿的有效率显著高于CTX组(x2=4.607,P＜0.05).TAC组患儿的不良反应发生率显著低于CTX组(x2=4.043,P＜0.05).结论 TAC治疗儿童紫癜性肾炎有效率高,且服用方便,不良反应小.