| Objective To analyze and compare the changes of immune function,clinical efficacy and adverse reactions of children with Henoch-Schonlein purpura nephritis before and after treatment with two different immunosuppressants,mycophenolate and cyclophosphamide,combined with glucocorticoid.Methods The clinical data of 92 in-patients with purpura nephritis admitted to Anhui Children’s Hospital from September 2017 to January 2022 were retrospectively collected.According to the differences in the use of immunosuppressive agents in the basic treatment of glucocorticoid,they were divided into two groups: observation group(MMF group): mycophenolate(MMF)+glucocorticoid,n=62;The control group(CTX group): cyclophosphamide(CTX)+glucocorticoid,n=30,collected blood routine test,alanine aminotransferase,alanine aminotransferase,serum albumin,serum creatinine,urea nitrogen,Ig G,Ig A,Ig M,lymphocyte percentage,24 h urine albumen,urine protein/creatinine and other related indicators before and 6 months after the treatment,and applied and monitored adverse reactions during the treatment,and analyzed the immune function changes of the two groups of children Clinical efficacy and incidence of adverse reactions.Result1.Six months after treatment with immunosuppressant,the values of Ig G,Ig A,CD4+/CD8+in the two groups were significantly lower than those before treatment,and the values of Ig M,CD3+,CD4+,CD8+were significantly higher than those before treatment;Compared with the control group,the values of Ig G,Ig A,CD4+/CD8+in the observation group were significantly decreased,and the values of Ig M,CD3+,CD4+,and CD8+were significantly increased in the observation group after treatment(p<0.05).2.Six months after treatment with immunosuppressive agents,the 24-hour urine protein quantity,blood creatinine and urea nitrogen levels of the two groups were significantly lower than those before treatment,and the serum albumin level was significantly higher than that before treatment;Compared with the control group,the 24-hour urine protein quantity,blood creatinine and urea nitrogen levels in the observation group were significantly decreased,and the serum albumin level was significantly increased in the observation group(p<0.05).3.Six months after the treatment of children with immunosuppressive agents,the complete remission rate was 9.7%,the partial remission rate was 80.6%,and the non-remission rate was 9.7% in the observation group;In the control group,the complete remission rate was 10.0%,the partial remission rate was 76.7%,and the non-remission rate was 13.3%.The total remission rate [cases(%)] of the two groups was [56(90.3)] in the observation group and [26(86.7)] in the control group,with no significant difference(p>0.05).4.In the observation group,there were 5 cases of elevated transaminase,9 cases of respiratory tract infection,2 cases of gastrointestinal reaction,0 case of bone marrow suppression,and 0 case of hemorrhagic cystitis;In the control group,there were 3 cases of elevated transaminase,7 cases of respiratory tract infection,3 cases of gastrointestinal reaction,0 cases of bone marrow suppression,and 1 case of hemorrhagic cystitis during the application of CTX.The incidence of adverse reactions between the two groups was 25.8% in the observation group and 46.6% in the control group.There was a significant difference between the two groups(p<0.05).Conclusion1.There are cellular immune disorders in children with HSPN,such as decreased CD4+,CD8+and imbalance of CD4+/CD8+ratio.2.Both MMF and CTX have immunosuppressive effects,and MMF has stronger inhibitory effects on Ig A,Ig M and Ig G in humoral immunity than CTX;Moreover,MMF has a stronger inhibitory effect on CD4+and CD8+in cellular immunity than CTX.3.MMF and CTX have the same clinical symptom remission rate for HSPN,but MMF can more effectively improve the levels of urine protein,serum creatinine and serum albumin.4.The incidence of adverse reactions in the treatment of HSPN with MMF is lower than that of CTX. |
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