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目的观察甲泼尼龙片联合吗替麦考酚酯胶囊治疗急性肾损伤的临床疗效和安全性。方法将72例急性肾损伤患者随机分为对照组36例和试验组36例。对照组予以口服吗替麦考酚酯,每次500 mg,bid,每疗程2周,连续治疗2个疗程;试验组在对照组的基础上予以口服甲泼尼龙,每次4 mg,tid,每疗程2周,连续治疗2个疗程。比较2组患者的临床疗效、治疗后3,7,15 d尿素氮(BUN)、血肌酸酐(Scr)及Notch蛋白的表达情况,以及药物不良反应发生率。结果治疗后,对照组和试验组的总有效率分别为69.44%(25/36例)和88.89%(32/36例),差异有统计学意义(P<0.05)。治疗3,7,15 d后,试验组和对照组BUN、Scr含量Notch蛋白指标明显低于治疗前;治疗后,试验组和对照组的血红蛋白指标分别为(123.46±10.36),(101.37±12.24)g·L~(-1),KIM~(-1)分别为(0.34±0.12),(0.93±0.39)ng·m L~(-1),SOD分别为(72.24±7.26),(84.86±9.71)U·m L~(-1),MDA分别为(4.05±0.51),(5.36±0.79)nmol·m L~(-1),差异有统计学意义(P<0.05)。试验组的药物不良反应主要有肝功能异常1例,感染1例,高血压1例;对照组的药物不良反应主要有肝功能异常1例,感染2例,高血压1例。试验组和对照组的药物不良反应发生率分别为8.33%(3/36例)和11.11%(4/36例),差异无统计学意义(P>0.05)。结论甲泼尼龙联合吗替麦考酚酯比单一使用吗替麦考酚酯治疗急性肾损伤临床疗效更佳,提高Notch蛋白的表达量,利于建立Notch/Hes1信号通路的,促进恢复血清细胞因子。
Objective To observe the clinical efficacy and safety of methylprednisolone tablets combined with mycophenolate mofetil in the treatment of acute renal injury. Methods A total of 72 patients with acute renal injury were randomly divided into control group (36 cases) and experimental group (36 cases). The control group was given oral mycophenolate mofetil, each 500 mg, bid for 2 weeks per course of treatment for two courses; the experimental group was given methylprednisolone orally on the basis of the control group, each 4 mg, tid, Each treatment for 2 weeks, continuous treatment of 2 courses. The clinical curative effect, the expression of BUN, Scr and Notch protein on 3, 7 and 15 days after treatment were compared between the two groups, and the incidence of adverse drug reactions were also observed. Results After treatment, the total effective rate was 69.44% (25/36 cases) and 88.89% (32/36 cases) respectively in the control group and experimental group, the difference was statistically significant (P <0.05). After treatment for 3, 7, and 15 days, the indexes of Notch of BUN and Scr in test group and control group were significantly lower than those before treatment. After treatment, the indexes of hemoglobin in test group and control group were (123.46 ± 10.36), (101.37 ± 12.24 (0.34 ± 0.12) and (0.93 ± 0.39) ng · m L -1, respectively, and the SOD values were (72.24 ± 7.26) and (84.86) g · L -1, ± 9.71) U · m L -1 and MDA were (4.05 ± 0.51) and (5.36 ± 0.79) nmol · m L -1, respectively, with significant difference (P <0.05). There were 1 cases of abnormal liver function, 1 case of infection and 1 case of hypertension in the adverse drug reactions of the experimental group. The adverse reactions of the control group were mainly liver dysfunction in 1 case, infection in 2 cases and hypertension in 1 case. The adverse drug reaction rates in trial group and control group were 8.33% (3/36 cases) and 11.11% (4/36 cases) respectively, with no significant difference (P> 0.05). CONCLUSION: Methylprednisolone combined with mycophenolate mofetil is more effective than single use of mycophenolate mofetil in the treatment of acute kidney injury, which can increase the expression of Notch protein and promote the formation of Notch / .