| 摘要: |
| 目的：观察他克莫司联合激素对激素耐药难治性肾病患儿调节性T（Treg）细胞的影响及其临床疗效。方法：选取2012年8月至2014年12月余姚市第二人民医院儿科常规激素治疗无效的肾病综合征患儿40例，另选取我院保健中心体检的健康儿童40例作为正常对照。Treg细胞使用流式细胞仪检测，对比治疗前后24 h尿蛋白定量、血肌酐、血清白蛋白、丙氨酸转氨酶、天门冬氨酸转氨酶、胆固醇、甘油三脂等临床指标的变化。结果：健康儿童、患儿治疗前和治疗后Treg细胞在外周血的比例分别为7.12%±1.64%、1.84%±0.51%、6.08%±1.23%，三组比较差异有统计学意义（P<0.05）。他克莫司治疗后患儿24 h尿蛋白定量从（113.2±24.3）mg/kg减少至（24.2±3.6）mg/kg（P<0.01），血清白蛋白从(19.2±2.5) g/L升高至(34.8±4.7) g/L（P<0.01），差异均有统计学意义；血肌酐治疗前后比较差异无统计学意义（P>0.05）。他克莫司治疗后患儿胆固醇和甘油三脂分别从（12.1±2.3）mmol/L和（5.9±1.2）mmol/L下降至（4.3±1.1）mmol/L和（2.8±0.6）mmol/L，差异均有统计学意义（P<0.01）。他克莫司治疗前后患儿丙氨酸转氨酶和天门冬氨酸转氨酶水平比较差异无统计学意义（P>0.05）。40例激素耐药难治性肾病患儿经他克莫司治疗后临床缓解率为82.5%，不良反应发生率为12.5%。结论：他克莫司可以显著升高激素耐药肾病患儿Treg细胞的比例，调节患儿的免疫失衡，对激素耐药肾病患儿具有显著临床疗效，使用安全，有一定的临床推广使用价值。 |
| 关键词: 他克莫司 肾病综合征 儿童 调节性T细胞 激素耐药 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.03.007 |
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| 基金项目: |
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| The Effect of Tacrolimus Combined with Steroid on Immunity in Children with Steroid-Resistant Intractable Nephrotic Syndrome and Its Clinical Efficacy |
| Zhou Youli, Shen Zenghui, Yao Yun, Wang Shuying |
| (The N0 2. People’s Hospital of Yutao, Zhejiang Province, Zhejiang Yuyao 315400, China) |
| Abstract: |
| Objective: To detect the effect of tacrolimus combined with steroid on Treg cells in in children with steroid-resistant intractable nephrotic syndrome (SRNS) and and explore its clinical efficacy. Methods: A total of 40 children with SRNS were enrolled in this study. Another 40 cases of healthy children were used as normal control. The Treg cells were detected by cytometry analysis. The 24 h urinary protein, Scr, Alb, ALT, TC, TG were compared. Results: The percent of Treg cells in healthy children, SRNS children(before treatment), and SRNS children(after treatment) was 7.12%±1.64%, 1.84%±0.51%, and 6.08%±1.23%. There was significant difference among three groups (P<0.05). After treatment, 24 h urinary protein was decreased from (113.2±24.3) mg/kg to (24.2±3.6) mg/kg (P<0.01), Alb was increased from (19.2±2.5) g/L to (34.8±4.7) g/L (P<0.01). However, there was no significant changes of Scr after treatment (P>0.05). After treatment, TC and TG was decreased from (12.1±2.3) mmol/L and (5.9±1.2) mmol/L to (4.3±1.1) mmol/L and (2.8±0.6) mmol/L (P<0.01). The clinic remission rate was 82.5%, with a clinical adverse reaction rate of 2.5%. Conclusion: Tacrolimus could increase the percentage of Treg cells in children with SRNS. Which regulated immune disorder and was conducive to treat SRNS children, with worthy of clinical application. |
| Key words: Tacrolimus Nephrotic syndrome Children Treg cells Steroid-resistant |
