左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效及对血清sPD-1 sPD-L1的影响

doi:10.3969/j.issn.1006-6233.2020.08.013

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摘要 目的: 探讨左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效及对血清可溶性程序性死亡受体1(sPD-1)、可溶性程序性死亡受体配体1(sPD-L1)的影响。方法: 选择2016年1年至2018年10月我院接诊的原发性肾病综合征患儿90例, 通过随机数表法, 分为观察组和对照组, 每组45例, 在基础治疗上, 对照组给予醋酸泼尼松片治疗, 观察组联合左旋咪唑治疗。连续治疗8周后, 比较两组临床疗效、24h尿蛋白定量、白蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)、免疫球蛋白(Ig)、T淋巴细胞亚群、血清sPD-1、sPD-L1的变化及6个月复发率。结果: 治疗后, 观察组临床疗效总有效率明显高于对照组(95.56%vs82.22%)(P<0.05);观察组24h尿蛋白定量、TC、TG分别为(0.35±0.08)g、(5.05±0.74)mmoL/L、(1.35±0.20)mmoL/L, 均明显低于对照组的(0.74±0.19)g、(5.82±0.69)mmoL/L、(1.69±0.23)mmoL/L, 观察组ALB为(38.94±3.71)g/L, 明显高于对照组的(34.12±3.90)g/L, 差异均有统计学意义(P<0.05);观察组IgG、IgA、IgM、CD4⁺、CD4⁺/CD8⁺分别(9.21±1.68)g/L、(0.90±0.15)g/L、(1.48±0.12)g/L、(40.23±2.17)%、(1.52±0.19), 明显高于对照组的(7.65±1.84)g/L、(0.79±0.13)g/L、(1.33±0.09)g/L、(37.46±2.29)%、(1.38±0.15), 差异均有统计学意义(P<0.05);观察组血清sPD-1、sPD-L1分别为(1.11±0.25)ng/mL、(69.56±7.40)pg/mL, 均明显低于对照组(1.63±0.36)ng/mL、(82.36±8.27)pg/mL, 差异均有统计学意义(P<0.05);随访6个月显示, 观察组复发率明显低于对照组(7.00%vs20.00%)(P<0.05)。结论: 左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效明显, 有助于改善实验室指标、减少复发率, 其内在机制可调节免疫功能及血清sPD-1、sPD-L1相关, 值得应用推广。

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关键词 ：原发性肾病综合征, 儿童, 糖皮质激素, 左旋咪唑, 免疫功能

Abstract：Objective: To study the curative efficacy of levamisole combined with glucocorticoid in treatment of children with primary nephrotic syndrome and its effects on serum soluble programmed death receptor 1(sPD-1) and soluble programmed death receptor ligand 1(sPD-L1) levels. Methods 90 children with primary nephrotic syndrome who received therapy from January 2016 to October 2018 in our hospital were selected, according to the random number table, and they were divided into the observation group and the control group, 45 cases in each. Besides basic treatment, the control group was treated with prednisone acetate tablets, and the observation group was additionally administered levamisole. After continuous treatment of 8 weeks, the clinical efficacy, the changes of the 24-hour urine protein quantity, albumin(ALB), total cholesterol (TC), triglyceride (TG), immunoglobulin(Ig), T lymphocyte subsets, serum sPD-1, sPD-L1 and recurrence rate of 6 months were compared between the two groups. Results: After treatment, the total effective rate of the observation group was significantly higher than that the control group(95.56%vs82.22%)(P＜0.05); the 24-hour urine protein quantity, TC, TG in the observation group were (0.35±0.08)g, (5.05±0.74)mmol/L and (1.35±0.20)mmol/L, which were significantly lower than the control group (0.74±0.19)g, (5.82±0.69)mmol/L and (1.69±0.23)mmol/L. The ALB in observation group were (38.94±3.71)g/L, which were significantly higher than the control group (34.12±3.90)g/L, anf the difference was statistically significant(P<0.05); the IgG, IgA, IgM, CD4⁺ and CD4⁺/CD8⁺ were (9.21±1.68)g/L, (0.90±0.15)g/L, (1.48±0.12)g/L, (40.23±2.17)%, (1.52±0.19), which were significantly higher than the control group(7.65±1.84)g/L, (0.79±0.13)g/L, (1.33±0.09)g/L, (37.46±2.29)%, (1.38±0.15), and the difference was statistically significant(P<0.05); the serum sPD-1, sPD-L1 in the observation group were (1.11±0.25)ng/ml and (69.56±7.40)pg/ml, which were significantly lower than the control group(1.63±0.36)ng/ml and (82.36±8.27)pg/ml, the difference was statistically significant(P<0.05); the follow-up for 6 months showed that the recurrence rate in the observation group was significantly lower than that in the control group(7.00%vs20.00%)(P<0.05). Conclusion: Levamisole combined with glucocorticoid is effective for children with primary nephrotic syndrome, which can effectively improve the laboratory indexes and reduce the recurrence rate. It's internal mechanism may regulate the immune function and serum sPD-1 and sPD-L1, and it's worth popularizing.

Key words： Primary nephrotic syndrome Children Glucocorticoid Levamisole Immune function

基金资助:湖南省教育厅科学研究项目, (编号:16C1392)

通讯作者: 邓秀兰

引用本文:

李小梅, 邓秀兰, , 唐绘卓. 左旋咪唑联合糖皮质激素治疗原发性肾病综合征患儿的疗效及对血清sPD-1 sPD-L1的影响[J]. 河北医学, 2020, 26(8): 1286-1290.
LI Xiaomei, DENG Xiulan. Efficacy of Levamisole Combined with Glucocorticoid in Treating Primary Nephrotic Syndrome of Children and Its Effects on Serum SPD-1 and SPD-L1 Levels. HeBei Med, 2020, 26(8): 1286-1290.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.08.013 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I8/1286

[1] 张小鸽, 李喆, 李志娟, 等.儿童肾性急性肾损伤病因及预后影响因素研究[J].中国全科医学, 2017, 20(18):2208~2212, 2217.
[2] Stabouli S, Chrysaidou K, Kupferman JC, et al. Neurological complications in childhood nephrotic syndrome: a systematic review[J]. Eur J Paediatr Neurol, 2019, 23(3): 384~391.
[3] 陈娣, 吴甫民.百令胶囊辅助治疗原发性肾病综合征疗效及对细胞免疫功能、微炎症状态的影响[J].陕西中医, 2017, 38(12):1670~1672.
[4] Costello J. Immunization recommendations for pediatric patients with chronic kidney disease, nephrotic syndrome, and renal transplants: a literature review and quality improvement project[J]. Nephrol Nurs, 2019, 46(4): 413~445.
[5] 李姜惠子, 刘洋, 王秀娟, 等.sPD-1/sPD-L1与Th1/Th2及Th17/Treg相关细胞因子在原发免疫性血小板减少症中的研究[J].中国免疫学杂志, 2019, 35(4):467~470.
[6] 杨霁云, 白克敏.小儿肾脏病基础与临床[M].北京:人民卫生出版社, 2000.126~135.
[7] Hollis A, Dart A, Morgan C, et al. Delays in diagnosis of nephrotic syndrome in children: a survey study[J]. Paediatr Child Health, 2019, 24(4): 258~262.
[8] Wang CS, Greenbaum LA. Nephrotic Syndrome[J]. Pediatr Clin North Am, 2019, 66(1): 73~85.
[9] 全诗翠, 胡佳, 刘畅, 等.免疫靶点PD-1/PD-L1的研究现状与应用进展[J].实用医学杂志, 2018, 34(14):2283~2286.
[10] 陈如月, 李晓忠, 朱赟, 等.原发性肾病综合征患儿血、尿中可溶性程序性死亡受体1和配体1水平及其临床意义[J].中华肾脏病杂志, 2019, 35(3):170~176.
[11] 李冰, 杨濛, 翟文生.槐杞黄颗粒联合糖皮质激素治疗儿童原发性肾病综合征Meta分析[J].中国中西医结合杂志, 2019, 39(2):169~177.
[12] 张雪丽, 刘翠华, 厉洪江, 等.桂枝茯苓汤联合激素治疗小儿原发性肾病综合征疗效及对患者血清炎性因子的影响[J].陕西中医, 2018, 39(11):1609~1612.
[13] 叶雪丹, 徐彤彤, 陆园园, 等.盐酸左旋咪唑对免疫低下小鼠免疫功能的影响[J].中国临床药理学杂志, 2019, 35(6):550~552, 570.
[14] Mohamed EH, Baiomy AA, Ibrahim ZS, et al. Modulatory effects of levamisole and garlic oil on the immune response of Wistar rats: biochemical, immunohistochemical, molecular and immunological study[J]. Molecular medicine reports, 2016, 14(3): 2755~2763.
[15] 黄忠, 冯杰, 杨振中.左旋咪唑与槐杞黄颗粒在儿童激素敏感型肾病综合征中的应用价值比较[J].河南医学研究, 2018, 27(21):3871~3873.