| ObjectiveTo investigate the clinical efficacy and adverse reactions of tacrolimus,mycophenolate mofetil and cyclophosphamide in combination with glucocorticoid on purpura nephritis in children and its effect on 24-hour urine protein,urine erythrocyte numbe,renal function,blood lipids,and immune function.Methods:A total of 88 children with purpura nephritis admitted to our hospital from January 2014 to June 2017 were randomly divided into group A(n = 22),group B(n = 30)and group C(n = 36).Patients in group A were treated with tacrolimus and glucocorticoid,patients in group B were treated with glucocorticoid plus cyclophosphamide,and patients in group C were treated with glucocorticoid plus mycophenolate mofetil.Three groups were treated 6 months after the gradual reduction to withdrawal.The levels of 24 h urinary protein,urine red blood cell count,Urinary albumin,transferrin,urinary immunoglobulin G,α1-microglobulin,β2-microglobulin,N-acetylglucosaminidase),urinary protein / creatinine),Liver function(serum albumin,alanine aminotransferase),renal function(serum creatinine,blood urea nitrogen)and immune function(Ig A,Ig M,Ig G,,CD3+,CD4+/CD8+,CD3+-CD19+)were recorded before treatment,after treatment for 3 and 6 months.The clinical efficacy and adverse reactions were compared in three groups of children.Results:(1)There was no significant difference in the clinical data of three groups of children in terms of gender,age and renal pathological grade(P> 0.05).(2)There was no significant difference in 24 h urinary protein and urinary erythrocyte count between the three groups before treatment(P> 0.05).At 3 and 6 months after treatment,the difference of 24 h urinary protein and urine red blood cell count were statistically significant(P <0.05).(3)There was no significant difference in serum Albumin,serum creatinine,blood urea nitrogen between the three groups before treatment(P> 0.05).At 3 and 6 months after treatment,the difference of serum Albumin,serum creatinine,blood urea nitrogen were statistically significant(P <0.05).(4)The levels of TC and TG in three groups of children were significantly decreased at 3 months and 6 months after treatment(P <0.05),but no significant difference was found in the three groups of children at 3 and 6 months after treatment(P> 0.05).There was no significant difference in TG levels between the three groups before treatment and before treatment(P> 0.05).(5)There was no significant difference in Ig A,Ig G and Ig M between the three groups before treatment(P> 0.05),and the differences of Ig A,Ig G and Ig M between the three groups were statistically significant at 3 and 6 months(P <0.05).(6)There was no significant difference in the levels of CD3 +,CD4 +/CD8 + and CD3+-CD19+ between the three groups before treatment(P> 0.05).The CD4 +,CD4 +/CD8 + and CD3+-CD19+(P <0.05).(7)The urine albumin(including urinary microalbumin,transferring,urinary immunoglobulin G,α1-microglobulin,β2-microglobulin,N-acetylglucosaminidase)were not significant(P> 0.05).Urine microalbumin,transferrin,urinary immunoglobulin G,α1-microglobulin N-acetylglucosaminidase were significant changed after treatment for 3 months and 6 months.(8)The total effective rate of group A was significantly higher than that of group B and group C(P <0.05).The total effective rate of group B was similar to that of group C(P> 0.05).(9)The total adverse reactions in group A were significantly higher than those in group B or group C(P <0.05),but there was no significant difference in the incidence of adverse reactions between group C and group B(P> 0.05).Conclusion:(1)Tacrolimus,mycophenolate mofetil and cyclophosphamide,respectively,in combination with glucocorticoid on purpura nephritis in children have a certain clinical efficacy.(2)Tacrolimus combined with glucocorticoid in the treatment of purpura nephritis in children is superior to mycophenolate mofetide combined with glucocorticoid and cyclophosphamide combined with glucocorticoid.Cyclophosphamide combined with glucocorticoid in the treatment of children purpura nephritis is better than in mycophenolate combination with glucocorticoid.(3)Although the effect of tacrolimus combined with glucocorticoid in treatment of children with purpura nephritis is good with convenient way of taking medicine,but its adverse drug reactions is high than that of mycophenolate mofetil combined with hormone or cyclophosphamide combined with hormone.The safety of mycophenolate mofetil and phosphoramidites is comparable with less adverse reactions than tacrolimus.The treatment in children with purpura nephritis should be chosen considering the condition of sick children. |
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