目的 探討使用他克莫司治療難治性腎病綜合征患兒的臨床效果以及對患兒體內(nèi)調(diào)節(jié)性T細胞（Regulatory T cells，Tregs）的影響。方法 將西安市兒童醫(yī)院自2012年1月—2017年1月收治的難治性腎病綜合征患兒120例作為研究對象，隨機分為研究組（n=60）和對照組（n=60）；研究組患兒選擇他克莫司進行治療，對照組采用環(huán)磷酰胺治療，兩組均治療6個月。觀察并記錄兩組患兒的臨床療效和治療前后Treg細胞水平、尿蛋白定量、血清白蛋白、血肌酐、丙氨酸氨基轉(zhuǎn)移酶、天門冬氨酸氨基轉(zhuǎn)移酶、膽固醇、三酰甘油等指標的水平變化情況。結果 研究組患兒治療的臨床總有效率為95.00%，明顯高于對照組的71.67%，差異有統(tǒng)計學意義（P<0.05）。與治療前相比，兩組治療后CD4⁺/CD25⁺顯著上升（P<0.05），同時研究組顯著高于對照組（P<0.05）。治療后，研究組和對照組患兒24 h尿蛋白定量水平均顯著低于治療前（P<0.05），且研究組顯著低于對照組（P<0.05）；兩組治療后血清白蛋白水平均顯著升高（P<0.05），且研究組顯著高于對照組（P<0.05）。但兩組治療前后血肌酐水平比較差異不顯著，兩組患兒治療前后ALT和AST水平比較差異不顯著。治療后，研究組和對照組膽固醇、三酰甘油顯著低于治療前（P<0.05），并且研究組膽固醇、三酰甘油含量顯著低于對照組（P<0.05）。結論 他克莫司治療難治性腎病綜合征患兒可有效提高患兒體內(nèi)Treg比例，調(diào)節(jié)患兒免疫失衡，改善患兒的腎功能和血脂水平，安全有效，具有較好的臨床推廣使用價值。

Objective To investigate the clinical efficacy of tacrolimus in the treatment of children with refractory nephrotic syndrome (Regulatory) and its influence on T cells (Tregs) in children. Methods the failure of conventional hormone therapy in our hospital from January 2012 to January 2017 were of the refractory nephrotic syndrome with 120 cases as the research object, Were randomly divided into 2 groups:Study Group (n=60) and control group (n=60), Study Groupwas chosen for tacrolimus treatment, and control group was treated by cyclophosphamide. Before and after treatment were measured with 24h urine protein, serum albumin, serum creatinine, alanine aminotransferase, aspartate the amino acid amino shift enzyme, the level of cholesterol and triglyceride in the index. Results The total effective rate of the treatment group was 95%, which was significantly higher than that of the control group (71.67%, P < 0.01). Compared with before treatment, the CD4⁺/CD25⁺ of the two groups increased significantly (P < 0.01), and the study group was significantly higher than the control group (P < 0.05). After treatment, the study group and the control group with 24 h urinary protein levels were significantly lower than before treatment, and the study group was significantly lower than the control group (P < 0.05), the serum albumin levels in two group were significantly increased after treatment, and the study group was significantly higher than control group (P < 0.05). Before and after treatment the level of serum creatinine in two groups was not significant. Before and after treatment in the two groups the level of ALT and AST were not significantly different. After treatment, the study group and the control group of cholesterol, triglyceride was significantly lower than that before treatment (P < 0.05) and, cholesterol, triglyceride content in study group were significantly lower than control group (P < 0.05). Conclusion tacrolimus in the treatment of refractory nephrotic syndrome in children can effectively improve the proportion of children in children with Treg, regulating immune imbalance, improve renal function and blood lipid levels, is safe and effective, has good clinical application value.