Single-center Efficacy Analysis Of Mycophenolate Mofetil And Cyclophosphamide Combined With Glucocorticoid In The Treatment Of Severe Henoch-schonlein Purpura Nephritis In Children

Objective:To explore the effect and safety of mycophenolate mofetil（MMF）and glucocorticoid on severe Henoch-Schonlein purpura nephritis in children and compared with cyclophosphamide（CTX）.Methods:To retrospectively analyze the efficacy of MMF and CTX combined with glucocorticoid in the treatment of severe Henoch-Sch（?）nlein purpura nephritis with nephrotic proteinuria.A total of 70 children who were hospitalized in the Pediatric Nephrology Department of the First Hospital of Jilin University from January 2009 to December 2020 were involved,with the diagnosed of HSPN and the characteristic of nephrotic proteinuria.The subjects were divided into 2 groups.35 cases were in the MMF group:MMF（20～30 mg/kg/d）+prednisone,and 35 cases in the CTX group:CTX（8～12 mg/kg/d）+prednisone.Clinical and laboratory data were collected at baseline and 1,2,3,6,9,12 months after treatment.During follow-up,cumulative retreatment rate,retreatment time and adverse reactions during after treatment were recorded.The factors that may influence the effect of mycophenolate mofetil and cyclophosphamide（different clinical types,pathological types）were analyzed.Results:In two groups after treatment for 1,2,3,6,9 and 12 months,24 hours urinary protein quantitative and hematuria were significantly lower than the baseline value,serum albumin was significantly higher than the baseline value,and serum creatinine indicated no statistically significant difference during the follow-up period.After the treatment of 1,2,3 months,the efficient rate of CTX group was higher than the MMFgroup,the effective treatment at the follow-up,no statistically significant difference were observed in the accumulative remission rate.There was statistically significant difference in the time to complete retreatment between the MMF group（median retreatment time of 6 months,95%CI 4.21～7.80）and CTX group（median retreatment time of 3 months,95%CI 2.34～3.66）after treatment（X~2=5.984,P=0.014<0.05）.The incidence of adverse reactions of MMF group（32.6%）was obviously lower than CTX group（67.4%）at the end of the follow-up（P<0.001）.The incidence of adverse reactions of MMF group was lower than CTX group at the end of the follow-up,where two groups developed digestive tract symptoms.Cox analysis of the two groups showed that neither clinical classification nor pathological changes affected the proteinuria retreatment.Conclusion:1.The effect of MMF groups and CTX group are the same.2.The incidence of adverse reactions of MMF group are lower than those of the CTX group.3.The clinical types and renal pathological changes have no relevance with the prognosis of the patients of HSPN.