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目的探讨联合应用钙调磷酸酶抑制剂(他克莫司)治疗诱导期或维持期对霉酚酸酯耐药的儿童狼疮肾炎的临床疗效。方法选取重庆第三军医大学新桥医院自2011年2月至2013年9月收治的儿童狼疮肾炎患儿66例,随机分为对照组和观察组。其中,对照组31例,给予糖皮质激素、环磷酰胺联合的传统疗法进行治疗;观察组35例,给予糖皮质激素、霉酚酸酯、他克莫司联合应用的多靶点疗法进行治疗。比较两组患儿治疗前及治疗6个月后的临床效果,并比较两组患儿治疗过程中出现的不良反应。结果治疗后,观察组患儿系统性红斑狼疮疾病活动度(SLEDAI)评分、血肌酐、24 h尿蛋白水平均低于对照组,血清补体C3、血浆白蛋白水平均高于对照组(P均<0.05)。治疗后,两组患儿SLEDAI评分、血肌酐、24 h尿蛋白水平均低于治疗前,血清补体C3、血浆白蛋白水平均高于治疗前(P均<0.05)。治疗期间,对照组31例患儿中有12例患儿出现不良反应,其中胃肠反应5例,呼吸道感染4例,带状疱疹3例,不良发应发生率为38.71%(12/31);观察组35例患儿中有5例患儿出现不良反应,其中胃肠反应3例,呼吸道感染1例,带状疱疹1例,不良发应发生率为14.29%(5/35),观察组低于对照组(P<0.05)。结论多靶点联合疗法和传统环磷酰胺疗法均能有效控制儿童狼疮肾炎,但多靶点联合疗法的临床效果更好,不良反应更少。
Objective To investigate the clinical efficacy of calcineurin inhibitor (tacrolimus) combined with mycophenolate mofetil in children with lupus nephritis during induction or maintenance period. Methods Sixty-six children with lupus nephritis who were admitted to Xinqiao Hospital of Chongqing Third Military Medical University from February 2011 to September 2013 were randomly divided into control group and observation group. Among them, 31 cases in the control group were given traditional therapy of glucocorticoid and cyclophosphamide. The observation group was treated with multi-targeted therapy combining glucocorticoid, mycophenolate mofetil and tacrolimus . The clinical effects of two groups of children before treatment and after 6 months of treatment were compared, and the adverse reactions in the two groups were compared. Results After treatment, SLEDAI score, serum creatinine, 24 h urinary protein level in the observation group were lower than those in the control group, serum complement C3 and plasma albumin levels were higher in the observation group than in the control group (P <0.05). After treatment, SLEDAI score, serum creatinine, 24 h urine protein level in both groups were lower than before treatment, serum complement C3 and plasma albumin levels were higher than before treatment (all P <0.05). During the treatment period, 12 children in the control group had adverse reactions, of which 5 were gastrointestinal reactions, 4 were respiratory infections and 3 were herpes zoster. The incidence of adverse reactions was 38.71% (12/31) ; 5 cases of 35 children in the observation group had adverse reactions, including 3 cases of gastrointestinal reaction, 1 case of respiratory tract infection, 1 case of shingles and 14.29% (5/35) cases of adverse reactions. Group lower than the control group (P <0.05). Conclusions Multi-target combination therapy and traditional cyclophosphamide therapy can effectively control lupus nephritis in children, but the multi-target combination therapy has better clinical effect and fewer side effects.