多靶点治疗难治性成人肾病综合征疗效观察

目的：探讨多靶点治疗对难治性成人肾病综合征(RNS)患者肾功能的影响。方法选取2012年5月至2014年5月我院肾内科收治的78例RNS患者作为研究对象，采用数字随机表法分为对照组和观察组各39例，均给予常规治疗，观察组给予泼尼松+霉酚酸酯+他克莫司治疗，对照组给予泼尼松+环磷酰胺，治疗前后检测两组患者24 h尿蛋白定量、血清白蛋白(ALB)、血肌酐(Scr)水平，以及白细胞介素-8(IL-8)、尿白细胞介素-6(IL-6)及T淋巴细胞水平。评估两组患者的疗效及用药安全性。结果观察组患者治疗有效率为71.79%(28/39)，明显高于对照组的41.03%(16/39)，差异具有统计学意义(P<0.05)；观察组患者治疗后24 h尿蛋白定量、Scr水平明显低于对照组(0.71±0.82) g/24 h vs (1.30±1.06) g/24 h、(70.26±9.66)μmol/L vs (76.27±10.28)μmol/L]，ALB明显高于对照组(36.87±6.29) g/L vs (32.04±5.28) g/L]，差异均具有统计学意义(P<0.05)；观察组患者治疗后的IL-6、IL-8水平均明显下降，且低于对照组(42.34±9.37) pg/ml vs (63.68±8.23) pg/ml、(59.86±9.85) pg/ml vs (81.06±5.29) pg/ml]，差异均具有统计学意义(P<0.05)；观察组患者治疗后的CD3+、CD4+、CD4+/CD8+均明显高于对照组(63.39±5.29)%vs (58.67±6.07)%、(36.11±5.16)%vs (31.05±5.97)%、(1.53±0.71)%vs (1.27±0.86)%]，差异均具有统计学意义(P<0.05)。观察组和对照组的不良用药反应率分别为25.64%(10/39)和30.77%(12/39)，差异无统计学意义(χ2=0.25，P>0.05)。结论泼尼松+霉酚酸酯+他克莫司多靶点治疗RNS能够改善肾功能，维持机体免疫功能，提高临床疗效。

Curative effect of multi-target therapy in adult patients with refractory nephrotic syndrome

Objective To investigate the effects of multi-target therapy on renal function of patients with refrac-tory nephrotic syndrome (RNS). Methods Seventy-eight patients with RNS who were admitted into our hospital be-tween May 2012 and May 2015 were selected as the study subjects, which were randomly divided into the control group and the observation group by a random number table, with 39 patients in each group. All the patients were given routine therapy. The observation group was treated with prednisone combined with mycophenolate mofetil and tacrolimus, while the control group was treated with prednisone and cyclophosphamide. The levels of 24 h urinary protein quantification, serum albumin (ALB), serum creatinine (Scr), interleukin-8 (IL-8), urine interleukin-6 (IL-6) and T lymphocytes in the two groups of patients were detected before and after treatment. The curative effects and safety of medication in the two groups were evaluated. Results The effective rate in the observation group (71.79%, 28/39) was significantly higher than that in the control group (41.03%, 16/39), P<0.05. The levels of 24 h urine protein quantification and Scr in the observation group after treatment were significantly lower than those in the control group (0.71±0.82) g/24 h vs (1.30±1.06) g/24 h, (70.26±9.66)μmol/L vs (76.27±10.28)μmol/L], while ALB was significantly higher than that in the control group (36.87±6.29) g/L vs (32.04±5.28) g/L], P<0.05. After treatment, levels of IL-6 and IL-8 in the observation group decreased significantly and were lower than those in the control group (42.34 ± 9.37) pg/ml vs (63.68 ± 8.23) pg/ml, (59.86 ± 9.85) pg/ml vs (81.06 ± 5.29) pg/ml], P<0.05. CD3+, CD4+, CD4+/CD8+ in the observation group after treat-ment were significantly higher than those in the control group (63.39±5.29)%vs (58.67±6.07)%, (36.11±5.16)%vs (31.05±5.97)%, (1.53±0.71)%vs (1.27±0.86)%], P<0.05. Conclusion Multi-target therapy with prednisone, mycophe-nolate mofetil and tacrolimus in the treatment of RNS can improve the renal function, maintain body's immune function and improve the clinical efficacy.