摘要
目的:探讨大剂量黄芪注射液联合霉酚酸酯对小儿狼疮性肾炎的临床效果。方法:将2016年9月至2018年7月河北医科大学附属河北省儿童医院肾脏免疫科收治的64例狼疮性肾炎患儿采用随机数字表分组,西药组常规给予糖皮质激素和霉酚酸酯,联合组常规西药治疗的同时给予大剂量黄芪注射液。对比治疗前后系统性红斑狼疮疾病的活动指数(SLEDAI)评分、临床疗效、治疗前后肾功能、狼疮性肾炎相关实验室检查指标、细胞免疫学指标和免疫细胞分泌的特征性细胞因子变化。结果:2组患儿的临床疗效分布比较差异有统计学意义(P<0.05);治疗前2组SLEDAI评分、血尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白定量、尿微量白蛋白、尿β2微球蛋白、T淋巴细胞亚群CD3^(+)、CD4/+CD8^(+)、Th17、CD4^(+)CD25highTreg、IL-17、IL-21、IL-10水平差异均无统计学意义(P>0.05);治疗后2组SLEDAI评分、BUN、Scr、24 h尿蛋白定量、尿微量白蛋白、尿β2微球蛋白、T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4/+CD8^(+)、Th17、IL-17、IL-21、IL-10水平均低于治疗前,差异均有统计学意义(P<0.05),联合组治疗后SLEDAI评分、BUN、Scr、24 h尿蛋白定量、尿微量白蛋白、尿β2微球蛋白、Th17、IL-17、IL-21、IL-10水平均低于西药组,而T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4/+CD8^(+)水平均高于西药组,差异均有统计学意义(P<0.05);治疗后2组CD4^(+)CD25highTreg、TGF-β1水平均较治疗前升高,且联合组均高于西药组,差异均有统计学意义(P<0.05);2组总不良反应发生率比较差异无统计学意义(P>0.05)。结论:对狼疮性肾炎患儿大剂量黄芪注射液联合霉酚酸酯可减轻症状,增强临床疗效,改善肾功能,控制病情,调节细胞免疫学指标和免疫细胞分泌的特征性细胞因子,且安全可靠。
Objective:To explore the clinical effect of large dose astragalus injection combined with mycophenolate mofetil in children with lupus nephritis.Methods:From September 2016 to July 2018,64 children with lupus nephritis admitted to the Department of Renal Immunology of Hebei Children's Hospital Affiliated to Hebei Medical University were divided into groups by a random digital table.The western medicine group were routinely given glucocorticoid and mycophenolate mofetil.The combined group were given high dose of astragalus injection on the routine method.The systemic lupus erythematosus disease activity index(SLEDAI)scores before and after treatment,clinical effect,changes of renal function,laboratory examination indexes related to lupus nephritis,and changes of cellular immune indexes and characteristic cytokines secreted by immune cells before and after treatment were compared.Results:There was a significant difference in the distribution of clinical efficacy between the two groups(P<0.05).There were no statistically significant differences in SLEDAI scores,the blood urea nitrogen(BUN),creatinine(Scr),24 h urinary protein,microalbumin andβ2-microglobulin were measured,T lymphocyte subsets CD8^(+),CD3^(+),CD4^(+),CD4/+CD8^(+),Th17,CD4^(+)CD25highTreg,IL-17,IL-21 and IL-10 between the two groups before treatment(P>0.05).After treatment,SLEDAI scores,BUN,Scr,24 h urinary protein,microalbumin,β2-microglobulin,the levels of T lymphocyte subsets CD3^(+),CD4^(+),CD4/+CD8^(+),Th17,IL-17,IL-21 and IL-10 levels in both groups were lower than those before treatment,with statistically significant differences(P<0.05),and the SLEDAI score,BUN,Scr and 24 h urinary protein,microalbumin andβ2-microglobulin,Th17,IL-17,IL-21 and IL-10 levels in the combination group after treatment were lower than those in western medicine group,while the levels of T lymphocyte subsets CD3^(+),CD4^(+),CD4/+CD8^(+)were higher than those in western medicine group,with statistically significant differences(P<0.05).The CD4^(+)CD25highTreg and TGF-β1 levels in the two groups after treatment increased compared with those before treatment,which in the combination group were higher than those in the western medicine group,with statistically significant differences(P<0.05).There was no significant difference in the total incidences of adverse reactions between the two groups(P>0.05).Conclusion:Large dose astragalus injection combined with mycophenolate mofetil in children with lupus nephritis can lessen the symptoms,enhance the clinical efficacy,but also improve renal function,control the disease,regulate the levels of cellular immunology and characteristic cytokines secreted by immune cells,which is safe and reliable.
作者
袁晓颖
李春珍
崔洁媛
YUAN Xiao-Ying;LI Chun-Zhen;CUI Jie-Yuan(Department of Renal Immunology,Children's Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2021年第15期1872-1876,共5页
Chinese Journal of Immunology
基金
2017年度河北省医学科学研究重点课题计划(20170047)资助。
关键词
黄芪注射液
霉酚酸酯
狼疮性肾炎
Astragalus injection
Mycophenolate ester
Lupus nephritis
