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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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

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

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