2019 年第 10 期 第 14 卷

吗替麦考酚酯联合甲泼尼龙冲击对过敏性紫癜肾损伤患儿肾功能的改善作用及对D-二聚体和白细胞介素水平的影响

Effect of mycophenolate mofetil combined with methylprednisolone on renal function, D-dimer and interleukin levels in children with Henoch-Schonlein purpura kidney injury

作者：陈小琳张韵洁赵燕李光谢佳任婧婧宋艳萍李罡灿

英文作者：

单位：710003西安交通大学附属西安市中心医院肾病科（陈小琳、赵燕），血液内科（张韵洁、李光、谢佳、任婧婧、宋艳萍、李罡灿）

英文单位：

关键词：过敏性紫癜；肾损伤；吗替麦考酚酯；甲泼尼龙；D-二聚体；白细胞介素

英文关键词：

• 摘要：

• 【摘要】目的    分析吗替麦考酚酯联合甲泼尼龙冲击对过敏性紫癜（HSP）肾损伤患儿肾功能的改善及对D-二聚体和白细胞介素(IL)水平的影响。方法    以2017年12月至2018年12月西安交通大学附属西安市中心医院诊治的HSP肾损伤患儿90例为研究对象。完全随机分为对照组和观察组，各45例。2组患儿均接受口服双嘧达莫、卡托普利和黄芪进行抗凝和改善肾循环治疗。另外，给予观察组患儿吗替麦考酚酯（口服）联合甲泼尼龙冲击（静脉滴注）和泼尼松（口服）治疗，给予对照组患儿吗替麦考酚酯（口服）联合泼尼松（口服）治疗。观察2组患儿经治疗后肾功能的改善情况，酶联免疫吸附试验法分析治疗前后血清中D-二聚体和IL水平的变化。结果    治疗后2组患儿血尿素氮、血肌酐水平较治疗前均明显降低、且观察组低于对照组［（4.0±1.0）mmol/L比（4.5±1.1）mmol/L、（55±9）μmol/L比（63±9）μmol/L］，血尿酸水平较治疗前均明显升高、且观察组高于对照组［（340±33）μmol/L比（319±25）μmol/L］，差异均有统计学意义（均P<0.05）。治疗后2组患儿D-二聚体、CD146、IL-1β、IL-6、IL-10水平较治疗前均明显降低、且观察组低于对照组，差异均有统计学意义（均P<0.05）。2组患儿均无严重的不良反应发生。结论    吗替麦考酚酯联合甲泼尼龙冲击有效改善HSP肾损伤患儿肾功能，且对异常的D-二聚体和IL水平有明显的恢复作用。

• 【Abstract】Objective    To investigate the effect of mycophenolate mofetil combined with methylprednisolone on renal function, D-dimer and interleukin（IL） levels in children with Henoch-Schonlein purpura(HSP) kidney injury. Methods    From December 2017 to December 2018, 90 children with HSP kidney injury admitted to Xi′an Central Hospital Affiliated to Xi′an Jiaotong University were randomly divided into control group and observation group, with 45 cases in each group. Both groups received oral dipyridamole, captopril and Astragalus membranaceus for anticoagulation and improvement of renal circulation. In addition, the observation group was treated with mycophenolate mofetil(oral) combined with methylprednisolone(intravenous) and prednisone(oral). The control group was treated with mycophenolate mofetil(oral) combined with prednisone(oral). Renal function indexes were tested before and after treatment. Levels of serum D-dimer and IL were detected by enzyme linked immunosorbent assay. Results    After treatment, serum levels of nitrogen and creatinine significantly decreased and the levels in observation group were lower than those in control group［（4.0±1.0）mmol/L vs （4.5±1.1）mmol/L, （55±9）μmol/L vs （63±9）μmol/L］; blood uric acid level significantly increased and it was higher in observation group than that in control group［（340±33）μmol/L vs （319±25）μmol/L］(all P<0.05). Serum levels of D-dimer, CD146, IL-1β, IL-6 and IL-10 significantly decreased and the levels in observation group were lower than those in control group(all P<0.05). There were no serious adverse reactions occurring in both groups. Conclusion    Mycophenolate mofetil combined with methylprednisolone treating children with HSP can effectively improve renal function and promote the recovery of abnormal serum levels of D-dimer and IL.