【摘要】 目的 探讨氯沙坦联合甲泼尼龙治疗急性药物性间质性肾炎的效果与安全性。方法 70例急性药物性间质性肾炎患者,采用随机数字表法分为对照组及试验组,各35例。对照组施以甲泼尼龙治疗,试验组施以氯沙坦联合甲泼尼龙治疗。比较两组患者治疗前及治疗1个月后的肿瘤坏死因子-α（TNF-α）、白介素-1（IL-1）、白介素-10（IL-10）水平,治疗后的肾功能指标[血清肌酐（Scr）、血尿素氮（BUN）、尿液N-乙酰-β-D-氨基葡萄糖苷酶（U-NAG）、血清β₂微球蛋白（β₂-MG）]水平,症状消失时间与肾功能恢复正常时间,临床疗效,不良反应发生情况。结果 治疗前,两组患者的TNF-α、IL-1、IL-10水平比较,差异无统计学意义（P>0.05）；治疗1个月后,试验组患者的TNF-α（95.32±32.47）ng/L、IL-1（69.93±11.42）ng/L明显低于对照组的（130.62±38.71）、（82.07±5.81）ng/L,IL-10（202.36±50.34）ng/L明显高于对照组的（176.97±42.01）ng/L,差异具有统计学意义（P<0.05）。治疗后,试验组患者的Scr（89.16±23.47）μmol/L、BUN（7.16±2.82）mmol/L、U-NAG（20.47±5.42）U/L、β₂-MG（1.16±0.02）mg/L均低于对照组的（152.58±37.08）μmol/L、（9.36±3.24）mmol/L、（27.98±8.23）U/L、（1.29±0.08）mg/L,差异具有统计学意义（P<0.05）。试验组患者的血尿消失时间、蛋白尿消失时间、少尿期消失时间、多尿期消失时间、肾功能恢复正常时间分别为（10.06±2.59）、（10.52±3.06）、（3.58±1.36）、（4.45±2.16）、（23.14±2.51）d,均短于对照组的（12.16±2.27）、（11.98±2.74）、（7.19±1.74）、（9.28±2.74）、（28.41±2.84）d,差异具有统计学意义（P<0.05）。试验组患者的总有效率97.14%高于对照组的77.14%,差异具有统计学意义（P<0.05）。两组患者的不良反应发生率比较,差异无统计学意义（P>0.05）。结论 氯沙坦联合甲泼尼龙治疗急性药物性间质性肾炎具有良好的效果与较高的安全性,不仅能够有效的提升IL-10水平,降低TNF-α与IL-1水平,缩短症状消失时间与肾功能恢复正常时间,同时还能够改善肾功能指标与临床疗效。更多还原

【Abstract】 Objective To discuss the effect and safety analysis of losartan combined with methylprednisolone in the treatment of acute drug-induced interstitial nephritis.Methods A total of 70 patients with acute drug-induced interstitial nephritis were randomly divided into control group and experimental group,with 35 cases in each group.The control group was treated with methylprednisolone,and the experimental group was treated with losartan combined with methylprednisolone.Both groups were compared in terms of levels of tumor necrosis factor-α （TNF-α）,interleukin-1 （IL-1） and interleukin-10 （IL-10） before treatment and 1month after treatment,and renal function indexes[serum creatinine （Scr）,blood urea nitrogen （BUN）,N-acetyl-β-D-glucosaminidase （U-NAG）,serum β₂-microglobulin （β₂-MG）]after treatment levels,and the time to symptom disappearance,recovery time of renal function,clinical efficacy,and the occurrence of adverse reactions.Results Before treatment,there was no statistically significant difference in the levels of TNF-α,IL-1 and IL-10 between the two groups （P>0.05）.After 1 month of treatment,the TNF-α （95.32±32.47） ng/L and IL-1（69.93±11.42） ng/L in the experimental group were significantly lower than （130.62±38.71） and （82.07±5.81） ng/L in the control group,and the IL-10 （202.36±50.34） ng/L in the experimental group was significantly higher than （176.97±42.01） ng/L in the control group.All the differences were statistically significant （P<0.05）.After treatment,the Scr （89.16±23.47）μmol/L,BUN （7.16±2.82） mmol/L,U-NAG （20.47±5.42） U/L,β₂-MG（1.16±0.02） mg/L in the experimental group were lower than （152.58±37.08）μmol/L,（9.36±3.24） mmol/L,（27.98±8.23） U/L,（1.29±0.08） mg/L in the control group,and the differences were statistically significant（P<0.05）.The disappearance time of hematuria and proteinuria,disappearance time of oliguria,disappearance time of polyuria,and recovery time of renal function in the experimental group were （10.06±2.59）,（10.52±3.06）,（3.58±1.36）,（4.45±2.16）,and （23.14±2.51） d,which were shorter than （12.16±2.27）,（11.98±2.74）,（7.19±1.74）,（9.28±2.74）,and （28.41±2.84） d in the control group,and the differences were statistically significant （P<0.05）.The total effective rate in the experimental group was 97.14%higher than 77.14%in the control group,and the difference was statistically significant （P<0.05）.There was no statistically significant difference in the incidence of adverse reactions between the two groups （P>0.05）.Conclusion Losartan combined with methylprednisolone has good effect and high safety in the treatment of acute drug-induced interstitial nephritis,which can not only effectively increase IL-10 level,reduce TNF-α and IL-1 level,shorten the time to symptom disappearance and recovery time of renal function,but also improve renal function index and clinical efficacy.更多还原