泼尼松联合雷公藤多苷对膜性肾病患者血清PLA2R、BAFF水平的影响

目的:探讨泼尼松联合雷公藤多苷治疗膜性肾病的临床疗效及对血清M型磷脂酶A2受体(phospholipase A2 receptor,PLA2R)、B淋巴细胞活化因子(B lymphocyte activating factor,BAFF)水平的影响。方法:选取84例膜性肾病患者,根据随机数字表将患者分为观察组与对照组,各42例。对照组给予环磷酰胺间断冲击联合泼尼松治疗,观察组采用泼尼松联合雷公藤多苷治疗,疗程为12个月,记录两组患者临床治疗效果,治疗前后肾功能、凝血纤溶系统改善情况及血清PLA2R、BAFF水平变化情况。结果:观察组治疗1个月、3个月、6个月、12个月完全缓解率均高于对照组,治疗1个月、3个月、6个月、12个月时有效率比较,差异无统计学意义(P0.05)。观察组患者24小时尿蛋白定量、血肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)水平显著低于对照组(P0.05)。观察组治疗后血浆内皮素-Ⅰ(endothelin-Ⅰ,ET-Ⅰ)、Ⅰ型纤溶酶原激活因子抑制因子(type I plasminogen activator inhibitor,PAI-Ⅰ)水平显著低于对照组(P0.05),而纤溶酶原激活因子(the plasminogen activator,t-PA)显著高于对照组(P0.05)。观察组患者治疗后血清PLA2R、BAFF水平明显低于对照组(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论:泼尼松联合雷公藤多苷能有效改善膜性肾病患者肾功能及凝血纤溶系统功能,降低血清PLA2R、BAFF水平,可提高膜性肾病患者治疗效果。

Effects of Prednisone and Triptolide on Serum PLA2R and BAFF of Membranous Nephropathy Patients

Objective:To investigate the effect of prednisolone and tripterygium wilfordii polyglycoside on the efficacy of membranous nephropathy and the levels of phospholipase A2 receptor (PLA2R) and B lymphocyte activating factor (BAFF).Methods:S4 cases of patients with membranous nephropathy from June 2014 to June 2016 were divided into observation group (n =42) and control group (n =42) according to the random number table.The control group was given cyclophosphamide intermittent shock combined with prednisone treatment and the treatment group was treated with prednisone combined tripterygium wilfordii polyglycoside for 12 months.The neurological function,the improvement of coagulation and fibrinolysis system and the changes of serum PLA2R and BAFF of both groups were recorded before and after treatment.Results:The complete remission rate of the observation group was higher than that of the control group at the time of 1 month,3 months,6 months and 12 months.There was no statistical difference in the total effective rate of the observation group at the time of 1 month,3 months,6 months and 12 months (P ＞ 0.05).The levels of 24 h urinary protein,serum creatinine (Scr) and blood urea nitrogen (BUN) of observation group were significantly lower than that of the control group (P ＜ 0.05).The levels of plasma endothelin-Ⅰ (ET-Ⅰ) and type Ⅰ plasminogen activator inhibitor (PAI-Ⅰ) of the observation group were significantly lower than that of the control group,while the plasminogen activator (t-PA) was significantly lower than that of the control group (P ＜ 0.05).The levels of serum PLA2R and BAFF of observation group were lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion:Prednisone combined with tripterygium wilfordii polyglycoside can effectively improve the renal function and coagulation fibrinolytic system function,reduce the level of serum PLA2R,BAFF,and improve the treatment of patients with membranous nephropathy.