目的 探討環(huán)磷酰胺聯(lián)合卡托普利、甲潑尼龍?jiān)谛孩蟆艏?jí)紫癜性腎炎中的應(yīng)用價(jià)值。方法 選取2019年1月—2020年1月屯昌縣人民醫(yī)院治療的紫癜性腎炎患兒94例作為研究對(duì)象，依據(jù)治療方法將患者分為對(duì)照組與觀察組，每組各47例。對(duì)照組口服卡托普利片，0.5 mg/kg，3次/d；同時(shí)注射用甲潑尼龍琥珀酸鈉，10～20 mg/kg加入5%葡萄糖溶液100～200 mL，隔天沖擊1次，3次為1個(gè)療程。觀察組在對(duì)照組治療的基礎(chǔ)上給予注射用異環(huán)磷酰胺，10 mg/kg加入0.9%氯化鈉溶液250 mL，于2 h內(nèi)靜脈泵注，1次/d，連用2 d為l個(gè)療程，每隔3周重復(fù)1次，共沖擊治療6個(gè)療程。兩組均持續(xù)治療6個(gè)月。觀察兩組患者的臨床療效，同時(shí)比較兩組臨床癥狀緩解時(shí)間、腎功能指標(biāo)、腎小管間質(zhì)病理分級(jí)情況及血清白細(xì)胞介素-8（IL-8）和血管細(xì)胞黏附分子-1（VCAM-1）水平。結(jié)果 治療后，對(duì)照組和觀察組的總有效率分別為76.60%、91.49%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，觀察組關(guān)節(jié)痛、腹痛、便血或黑便及紫癜消失時(shí)間顯著短于對(duì)照組（P<0.05）。治療3、6個(gè)月后，兩組血清血肌酐（SCr）、尿素氮（BUN）、尿微量蛋白（mAlb）、24 h尿蛋白定量較治療前顯著降低，且觀察組顯著低于對(duì)照組同期（P<0.05）。治療后，觀察組腎小管間質(zhì)病理分級(jí)優(yōu)于對(duì)照組（P<0.05）。治療3、6個(gè)月后，兩組血清IL-8、VACM-1水平較治療前降低（P<0.05），且觀察組顯著低于同期對(duì)照組（P<0.05）。結(jié)論 環(huán)磷酰胺聯(lián)合卡托普利、甲潑尼龍治療小兒Ⅲ～Ⅳ級(jí)難治性紫癜性腎炎可下調(diào)IL-8、VCAM-1水平，改善腎小管間質(zhì)病理分級(jí)，在合理用藥基礎(chǔ)上不良反應(yīng)少，治療效果顯著。

Objective To explore the application value of cyclophosphamide combined with captopril and methylprednisolone in children with grade Ⅲ — Ⅳ purpura nephritis. Methods A total of 94 children with purpura nephritis treated in People's Hospital of Tunchang County from January 2019 to January 2020 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 47 cases in each group. Patients in the control group were po administered with Captopril Tablets, 0.5 mg/kg, three times daily. And injected with Methylprednisolone Sodium Succinate for Injection,10 — 20 mg/kg was added with 5% glucose solution 100 — 200 mL, and the solution was injected once every other day, three times as a course of treatment. Patients in the observation group were given Ifosfamide for Injection on the basis of control group, 10 mg/kg added with 250 mL 0.9% sodium chloride solution, intravenously pumped within 2 h, once a day, for 2 days as a course of treatment, repeated every 3 weeks, for a total of 6 courses of shock therapy. Both groups were treated continuously for 6 months. The clinical efficacy of two groups was observed, and the duration of clinical symptom remission, renal function indexes, renal tubulointerstitial pathological grading, and serum levels of IL-8 and VCAM-1 were compared between two groups. Results After treatment, the total effective rate of the control group and the observation group was 76.60% and 91.49%, respectively, and the difference between two groups was statistically significant (P < 0.05). After treatment, the disappearance time of arthralgia, abdominal pain, hemochezia or melena and purpura in the observation group was significantly shorter than that in the control group (P < 0.05). After 3 months and 6 months of treatment, the levels of serum SCR, BUN, mALB, and 24 h urinary protein in two groups were significantly decreased compared with before treatment, and the observation group was significantly lower than the control group (P < 0.05). After 6 months of treatment, the pathological grading of renal tubulointerstitial in the observation group was better than that in the control group (P < 0.05). After 3 and 6 months of treatment, the levels of serum IL-8 and VACM-1 in two groups were lower than before treatment (P < 0.05), and the observation group was significantly lower than the control group (P < 0.05). Conclusion Cyclophoshamide combined with captopril and methylprednylone in treatment of children with Ⅲ — Ⅳ grade purpura nephritis can downregulate the levels of IL-8 and VCAM-1, and improve the pathological grade of renal tubulointerstitial. On the basis of rational drug use, there are fewer adverse reactions, and the therapeutic effect is significant.

R984

海南省衛(wèi)生計(jì)生行業(yè)科研項(xiàng)目（18A200051）