目的 探討環(huán)孢素聯(lián)合潑尼松治療腎病綜合征患兒的臨床療效。方法 選擇新疆喀什地區(qū)第一人民醫(yī)院2016年1月-2018年12月收治的原發(fā)性腎病綜合征患兒96例作為研究對(duì)象，隨機(jī)分為對(duì)照組和觀察組，每組各48例。兩組患兒給予醋酸潑尼松片進(jìn)行治療，0.5 mg/（kg·d），最大劑量不超過60 mg/d，最長(zhǎng)使用8周后逐漸減少使用劑量，減至起始劑量的2/3，隔日晨頓服。對(duì)照組患兒靜脈滴注注射用環(huán)磷酰胺，使用劑量為8~12 mg/（kg·d），1次/月。觀察組患者分次口服環(huán)孢素軟膠囊，使用劑量3~5 mg/（kg·d），開始用藥后7~10 d根據(jù)患者血藥濃度調(diào)整劑量，誘導(dǎo)緩解期血藥濃度為72 μg/L，尿蛋白轉(zhuǎn)陰后可減少使用劑量，維持緩解期的血藥濃度為40 μg/L。兩組均治療3個(gè)月。觀察兩組患者的臨床療效，同時(shí)比較兩組患兒治療前后的免疫功能相關(guān)指標(biāo)和腎功能指標(biāo)水平。結(jié)果 治療后，觀察組總緩解率為91.67%，明顯高于對(duì)照組的72.92%（P<0.05）。治療后，兩組CD4⁺水平明顯升高，CD8⁺、干擾素（INF-γ）、白細(xì)胞介素（IL）-4、IL-6水平均降低（P<0.05），且觀察組的免疫指標(biāo)改善程度更顯著（P<0.05）。治療后，兩組血肌酐（Scr）、尿素氮（BUN）水平均降低，肌酐清除率（Ccr）水平明顯升高（P<0.05），且觀察組腎功能指標(biāo)改善程度更顯著（P<0.05）。結(jié)論 環(huán)孢素聯(lián)合潑尼松治療腎病綜合征的療效優(yōu)于環(huán)磷酰胺聯(lián)合潑尼松，可改善患者免疫功能和腎功能，安全性好，可在臨床范圍內(nèi)推廣使用。

Objective To investigate the clinical effects of ciclosporin combined with prednisone. Methods A total of 96 children with primary nephrotic syndrome admitted to First People's Hospital of Kashgar Area from January 2016 to December 2018 were selected as study subjects, and randomly divided into a control group and an observation group, with 48 patients in each group. Children in two groups were treated with Prednisone Acetate Tablets, 0.5 mg/(kg·d), the maximum dose not exceeding 60 mg/d. The maximum dose was reduced gradually after 8 weeks of use, and was reduced to 2/3 of the initial dose. Children in two groups were given Prednisone Acetate Tablets every other day in the morning. Children in the control group were iv administered with Cyclophosphamide for Injection at the dosage of 8-12 mg/(kg·d), once per month. Children in the observation group were po administered with Ciclosporin Soft Capsules for 3-5 mg/(kg·d), and the dose was adjusted according to the patient's blood concentration for 7 to 10 days after the treatment. The blood concentration in the induced remission period was 72 μg/L, and the dose could be reduced after the urine protein turned negative, and the blood concentration in the maintenance remission period was 40 μg/L. Both groups were treated for 3 months. The clinical efficacy of the two groups of patients was observed, and the immune function related indexes and renal function indexes of two groups were compared before and after treatment. Results After treatment, the total remission rate in the observation group was 91.67%, which was significantly higher than 72.92% in the control group (P<0.05). After treatment, CD4⁺ level was significantly increased in two groups, but CD8⁺, INF-γ, IL-4, and IL-6 levels were all decreased (P<0.05), and the improvement of immune indexes in the observation group was more significant (P<0.05). After treatment, Scr and BUN levels in two groups were decreased, Ccr level was significantly increased (P<0.05), and the improvement degree of renal function index in the observation group was more significant (P<0.05). Conclusion Ciclosporin combined with prednisone is more effective than cyclophosphamide combined with prednisone in treatment of nephrotic syndrome. It can improve the immune function and renal function of patients, and it is safe and can be widely used in the clinical scope.

R979.5