【摘要】 目的:观察吗替麦考酚酯(MMF)联合糖皮质激素治疗不同病理分级IgA血管炎肾炎(IgAVN)的疗效。方法:收集南方医科大学南方医院儿科2018-2024年诊治的59例IgAVN患儿临床资料。根据肾脏病理类型及药物治疗分为MMF组(Ⅱ-MMF组、Ⅲa-MMF组、Ⅲb-MMF组)、CTX组(Ⅲb-CTX组)。比较各组患儿临床疗效和不良反应发生情况。结果:Ⅱ-MMF组治疗6、12个月的完全缓解率分别为69.2%和84.6%,Ⅲ-MMF组分别为48.7%和76.7%,两组比较差异无统计学意义(均P>0.05)。Ⅲb-MMF组治疗6个月的完全缓解率为53.3%,Ⅲb-CTX组为12.5%,差异无统计学意义(P>0.05)。治疗6个月后患儿血清IgA、IgM水平下降(P<0.01)。CD4~+T细胞比例上升,B细胞各亚群比例下降,差异均有统计学意义(均P<0.05)。所有患儿均无严重不良反应。结论:MMF联合激素治疗可有效缓解病理Ⅱ级和Ⅲ级IgAVN患儿肾损伤,病理Ⅱ级患儿完全缓解率可能高于病理Ⅲ级,MMF和CTX均可有效缓解病理Ⅲb级IgAVN患儿肾损伤。更多还原

【Abstract】 Objective: To observe the therapeutic effect of mycophenolate mofetil( MMF) combined with glucocorticoids in the treatment of immunoglobulin A( IgA) vasculitis nephritis( IgAVN) of different pathological grades. Methods: Clinical data of 59 children with IgAVN diagnosed and treated in Pediatrics of Southern Hospital, Southern Medical University from 2018 to 2024 were collected. According to the pathological type of the kidneys and the classification of drug treatment, all patients were divided into the MMF group(Ⅱ-MMF group, Ⅲa-MMF group, Ⅲb-MMF group) and CTX group(Ⅲb-CTX group). The clinical efficacy and adverse drug reactions of each group were compared. Results: The complete remission rates of the Ⅱ-MMF group at 6 and 12 months of treatment were respectively 69. 2% and 84. 6%, while those of the Ⅲ-MMF group were respectively 48. 7% and 76. 7%, with no statistically significant difference between two groups(P>0. 05). The complete remission rate of the Ⅲb-MMF group at 6 months of treatment was 53. 3%, while that of the Ⅲb-CTX group was 12. 5%, with no statistically significant difference(P> 0. 05). After 6 months of treatment, the levels of serum IgA and IgM in the children decreased significantly(P<0. 01). The ratio of CD4~+ T cell increased, while all B cell subpopulations decreased significantly, with statistically significant difference(P<0. 05). No severe adverse drug reactions were observed in two groups. Conclusion: MMF combined with glucocorticoids can effectively alleviate renal damage in children with pathological grade Ⅱ and Ⅲ IgAVN. The complete remission rate in children with pathological grade Ⅱ may be higher than that in those with pathological grade Ⅲ. Both MMF and CTX can effectively alleviate renal damage in children with pathological grade Ⅲb IgAVN.更多还原