朱莉,邵维斌,夏春英,丁浩
ZHU Li,SHAO Weibin,XIA Chunying,DING Hao

• 1:江苏大学附属人民医院肾内科

摘要(Abstract)：

目的:探讨环磷酰胺联合糖皮质激素对原发性肾病综合征(PNS)患者肾功能和血脂的影响。方法:112例PNS患者,随机均分为实验组和对照组,对照组给予糖皮质激素治疗,实验组在对照组治疗的基础上加用环磷酰胺治疗;比较治疗前及治疗12月时2组患者血清尿素氮(BUN)、白蛋白(Alb)、血肌酐(Scr)、24 h尿蛋白定量(24Upro)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、脂蛋白a(LPa)、载脂蛋白A1(Apo A1)、载脂蛋白B(Apo B)水平及尿量,记录治疗期间2组患者的不良反应。结果:治疗前,2组患者肾功能及血脂代谢指标比较,差异无统计学意义(P> 0. 05);治疗12月时2组患者血清BUN、24Upro、TC、TG、LDL、LPa、Apo B水平均较治疗前显著降低,Alb、Scr水平、尿量较治疗前显著升高,实验组变化更明显(P <0. 05,或P <0. 01); 2组患者HDL、Apo A1水平较治疗前无明显变化(P> 0. 05); 2组患者总不良反应发生率比较,差异无统计学意义(χ2=2. 842,P=0. 092)。结论:糖皮质激素联合环磷酰胺可明显改善PNS患者肾功能及血脂代谢紊乱状态,效果优于单独糖皮质激素治疗。
Objective: To investigate the effect of cyclophosphamide combined with glucocorticoid on renal functions and blood lipids in patients with primary nephrotic syndrome(PNS). Methods: 112 patients with PNS in our hospital from April 2015 to January 2018 were selected and randomly divided into the experiment group and the control group,with 56 cases in each group. The control group was given glucocorticoid treatment,and the experiment group was added with cyclophosphamide on the basis of the treatment for the control group. Both groups were treated for 12 months. The changes of renal function and blood lipid metabolism indexes before and after treatment were compared between the 2 groups,and their incidence of adverse reactions was calculated. Results: Compared with before treatment,the levels of serum BUN and 24 Upro of both groups after treatment decreased significantly,and the experiment group's level was significantly lower than the control group's(P < 0. 01); their levels of Alb,Scr and urine volume increased significantly,and the experiment group's change was more obvious(P < 0. 05 or P < 0. 01). The levels of TC,TG,LDL,LPa and ApoB of the 2 groups in peripheral blood after treatment decreased significantly,and the experiment group 's levels were significantly lower than the controls'(P < 0. 05 or P < 0. 01). There was no significant change in the levels of HDL and ApoA1 in the 2 groups(P > 0. 05). The incidence of total adverse reactions in the experiment group had no significant increase compared with the control group(P < 0. 05). Conclusion: Glucocorticoid combined with cyclophosphamide can significantly improve renal functions and lipid metabolism disorder in patients with PNS. Its efficacy is better than glucocorticoid treatment alone,and it does not increase the incidence of adverse reactions.

关键词(KeyWords)： 环磷酰胺;糖皮质激素;原发性肾病综合征;肾功能;血脂
cyclophosphamide;glucocorticoid;primary nephrotic syndrome;renal function;blood lipids

Abstract:

Keywords:

基金项目(Foundation): 镇江市社会发展项目SH2013045

作者(Author): 朱莉,邵维斌,夏春英,丁浩
ZHU Li,SHAO Weibin,XIA Chunying,DING Hao

DOI: 10.19367/j.cnki.1000-2707.2018.11.020

参考文献(References)：

• [1]陈晓萌,苏建荣.原发性肾病综合征患者血脂代谢及免疫调节的临床研究[J].国际检验医学杂志,2014,35(9):1124-1125.
• [2]仉晓燕,李靖.中西医结合治疗小儿原发性肾病综合征的系统评价与Meta分析[J].世界中医药,2017,12(6):1451-1459.
• [3]LIANG Y,CHEN Y,CHEN Y,et al. Role of the glucocorticoid receptor in the recurrence of primary nephrotic syndrome[J]. Exp Therap Med,2015,10(4):1556-1562.
• [4]马曦立.环磷酰胺联合糖皮质激素治疗肾病综合征的临床疗效分析[J].中国现代药物应用,2016,10(14):147-148.
• [5]向林.中药对原发性肾病综合征糖皮质激素治疗的增效减毒作用[J].医学临床研究,2017,34(7):1952-1955.
• [6]常淑平,王勇,王韫芳.糖皮质激素联合环磷酰胺治疗肾病综合征49例[J].中国药业,2014,23(1):73-74.
• [7]陈灏珠.实用内科学[M].北京:人民卫生出版社,2013.
• [8]黄苗,王世东,肖永华,等.国医名师吕仁和应用中医药联合激素治疗原发性肾病综合征经验初探[J].环球中医药,2016,9(10):1265-1267.
• [9]刘力.儿童狼疮性肾炎治疗中环磷酰胺药物代谢的临床研究[D].天津:天津医科大学,2017.
• [10]耿海云,曹力,陈朝英,等.环磷酰胺与环孢素A治疗儿童激素耐药肾病综合征疗效比较[J].中国实用儿科杂志,2013,28(4):295-297.
• [11]赵雅堃,武红利,李雅钗,等.妊娠期肾病综合征患者脂代谢特点及对母婴结局的影响[J].贵州医科大学学报,2017,42(1):101-104.
• [12]VAZIRI N D. Disorders of lipid metabolism in nephrotic syndrome:mechanisms and consequences[J]. Kidney International,2016,90(1):41-52.
• [13]张颖.吗替麦考酚酯与环磷酰胺联合激素治疗成人难治性肾病综合征的疗效和安全性比较[J].现代中西医结合杂志,2017,26(6):596-598.
• [14]孙雪峰,陈美香.他克莫司在原发性肾病综合征治疗中的应用[J].中国实用内科杂志,2009,28(5):9-11.
• [15]李冀.神经钙调蛋白抑制剂、环磷酰胺治疗儿童激素耐药型肾病综合征疗效差异的系统评价[J].山东医药,2017,57(20):46-48.

文章评论(Comment)：