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      标题:霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎的疗效及其对患者血清CysC、TGF-β1、sTM的影响
      作者:卫鹏宇 1,王葳 2,朱胜保 1,张帆 1    (1.上海市普陀区利群医院肾内科,上海 200333;2.中国人民解放军第455医院肾内科,上海 200052)
      卷次: 2018年29卷19期
      【摘要】 目的 探讨霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎的疗效及其对患者血清胱抑素C (CysC)、转化生长因子-β1 (TGF-β1)、可溶性血栓调节蛋白(sTM)水平的影响。方法 从上海利普陀区立群医院2015年7月至2017年7月收治的狼疮性肾炎患者中选取86例作为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组给予厄贝沙坦治疗,观察组给予霉酚酸酯联合厄贝沙坦治疗,持续治疗6个月。治疗后比较两组患者的临床疗效、临床症状改善情况、CysC、TGF-β1、sTM、尿白蛋白排泄率(UAER)、尿β2微球蛋白(β2-MG)、24 h尿蛋白量、血白蛋白、血清肌酐(Scr)、补体C3水平及不良反应发生率。结果 观察组患者的治疗总有效率为95.35%,明显高于对照组的79.07%,差异有统计学意义(P<0.05);治疗后观察组患者的尿蛋白转阴、水肿消退、血压恢复正常、血尿消失、肾功能恢复正常等改善情况明显优于对照组,差异均有统计学意义(P<0.05);治疗后两组患者的CysC、TGF-β1、sTM水平与治疗前相比均明显降低,差异均有统计学意义(P<0.05),且观察组患者的CysC、TGF-β1、sTM水平[(1.23±0.34) mg/L、(51.92±9.86) pg/mL、(12.23±3.18) ng/mL]均明显低于对照组[(1.65±0.45) mg/L、(56.86±10.79) pg/mL、(29.15±7.06) ng/mL],差异均有统计学意义(P<0.05);治疗后两组患者的UAER、尿β2-MG、24 h尿蛋白量、血白蛋白、Scr水平与治疗前相比明显降低,C3水平明显升高,且组间比较差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为6.98%,与对照组的4.65%比较差异无统计学意义(P>0.05)。结论 霉酚酸酯联合厄贝沙坦治疗狼疮性肾炎能显著改善患者临床症状,下调血清CysC、TGF-β1、sTM表达,调节UAER、尿β2-MG、24 h尿蛋白量、血白蛋白、Scr、C3水平恢复正常,减轻患者肾脏损伤,促进肾功能改善,且安全性较高。
      【关键词】 霉酚酸酯;厄贝沙坦;狼疮性肾炎;胱抑素C;转化生长因子-β1;可溶性血栓调节蛋白
      【中图分类号】 R593.24+2 【文献标识码】 A 【文章编号】 1003—6350(2018)19—2707—04
Efficacy of Mycophenolate combined with Irbesartan in the treatment of lupus nephritis and its effect on serumCysC, TGF-β 1 and sTM. WEI Peng-yu 1, WANG Wei 2, ZHU Sheng-bao 1, ZHANG Fan 1. 1. Department of RenalMedicine, Shanghai Putuo Liqun Hospital, Shanghai 200333; 2. Department of Renal Medicine, the 455 Hospital of ChinesePeople's Liberation Army, Shanghai 200052, CHINA
      【Abstract】 Objective To investigate the effect of Mycophenolate combined with Irbesartan on clinical effica-cy and the effect on serum cystatin C (CysC), transforming growth factor-β 1 (TGF-β 1) and soluble thrombomodulin(sTM) in patients with lupus nephritis. Methods A total of 86 patients with lupus nephritis treated in Shanghai PutuoLiqun Hospital from July 2015 to July 2017 were selected as the research subjects. They were divided into observationgroup and control group according to the random number table method, with 43 cases in each group. The control groupwas treated with Irbesartan, and the observation group was given Mycophenolate combined with Irbesartan; the twogroups were treated for 6 months. After treatment, the clinical curative effect, clinical symptom improvement, CysC,TGF-β1, sTM, urinary albumin excretion rate (UAER), urinary β2 microglobulin (β2-MG), 24 h urine protein, serum albu-min, serum creatinine (Scr), complement C3 levels and incidence of adverse reactions were compared between twogroups of patients. Results The total effective rate of treatment in the observation group was 95.35%, which was signif-icantly higher than 79.07% in the control group (P<0.05). After treatment, the improvement in the observation group wassignificantly better than that in the control group, including urine protein negative conversion, edema regression, bloodpressure recovery, hematuria disappearance and renal function recovery (P<0.05). After treatment, the levels of CysC,TGF-β1 and sTM in the two groups were significantly lower than those before treatment (P<0.05). The levels of CysC,TGF-β1 and sTM in the observation group were (1.23±0.34) mg/L, (51.92±9.86) pg/mL, (12.23±3.18) ng/mL, respective-ly, significantly lower than (1.65±0.45) mg/L, (56.86±10.79) pg/mL, (29.15±7.06) ng/mL in the control group (P<0.05).After treatment, the levels of UAER, urine β2-MG, 24 h urine protein, serum albumin and Scr were significantly lowerthan those before treatment, and C3 levels were significantly increased (P<0.05). The incidence of adverse reactions inthe observation group was 6.98%, which was not statistically significant compared with 4.65% in the control group (P>·论 著·doi:10.3969/j.issn.1003-6350.2018.19.012

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