他克莫司联合糖皮质激素治疗儿童IgA肾病的疗效观察

Clinical effect of tacrolimus combined with glucocorticoid in the treatment of IgA nephropathy in children

摘要:

目的 观察他克莫司（TAC）和霉酚酸酯（MMF）分别联合糖皮质激素（GC）治疗儿童原发性IgA肾病（IgAN）的疗效及安全性。方法 回顾性分析2012年1月至2017年12月经肾脏病理证实为原发性IgAN患儿，根据治疗方案不同分为TAC组和MMF组。收集两组患儿治疗前及治疗1、3、6个月时的临床资料，比较研究期间IgAN的缓解情况和不良反应。结果 共纳入43例符合研究标准的患儿，TAC组15例，MMF组28例。治疗1月时两组患儿缓解情况差异无统计学意义（P > 0.05）；治疗3月及6月时TAC组缓解情况优于MMF组（P < 0.05）。治疗1月时TAC组血清白蛋白高于MMF组（P < 0.05）。两组在治疗后各时点的血清白蛋白均高于基线值，差异有统计学意义（P < 0.0083）；两组治疗3月及6月时肾小球滤过率（GFR）均高于基线值，差异有统计学意义（P < 0.0083）。研究期间两组患儿不良反应总发生率差异无统计学意义（P > 0.05），但TAC组有1例发生真菌感染。结论 TAC联合GC治疗儿童原发性IgAN有良好的减低尿蛋白的作用，近期疗效优于MMF，且安全性良好。

Abstract:

Objective To study the clinical effect and safety of tacrolimus (TAC) combined with glucocorticoid (GC) versus mycophenolate mofetil (MMF) combined with GC in the treatment of primary IgA nephropathy (IgAN) in children. Methods A retrospective analysis was performed for the clinical data of children with primary IgAN confrmed by renal pathology between January 2012 and December 2017. These children were divided into TAC group and MMF group according to the treatment regimen. Their clinical data before treatment and at 1, 3, and 6 months of treatment were collected, and the remission status of IgAN and adverse reactions were compared between the two groups. Results A total of 43 children who met the inclusion criteria were enrolled, with 15 children in the TAC group and 28 children in the MMF group. At 1 month of treatment, there was no signifcant difference in the remission status between the two groups (P > 0.05). At 3 and 6 months of treatment, the TAC group had a signifcantly better remission status than the MMF group (P < 0.05). At 1 month of treatment, the TAC group had higher serum albumin levels than the MMF group (P < 0.05). Both groups had a signifcant increase in serum albumin levels at each time point after treatment (P < 0.0083) and a signifcant increase in the glomerular fltration rate (GFR) at 3 and 6 months of treatment (P < 0.0083). There was no signifcant difference in the overall incidence rate of adverse reactions between the two groups (P > 0.05), but fungal infection was observed in one child from the TAC group. Conclusions TAC combined with GC can effectively reduce urinary protein in children with primary IgAN, and it has a better short-term clinical effect than MMF combined with GC, with good safety.