Mycophenolate Mofetil Versus Tacrolimus For Therapy Of Children Henoch-schonleinpurpura Nephritis:A Restrospectivelycompared Trial

Objective:Objective to study the efficacy and safety of mycophenolate mofetil and tacrolimus combined with prednisone in the treatment of children with nephrotic syndrome purpura nephritis.Methods:Taking 70 cases of children with purpurua nephritis hospitalized in the Pediatrics of the First Affiliated Hospital of Kunming Medical University from January 2015 to December 2019 as the research object,These 70 children were all in accordance with the diagnosis of purpuric nephritis nephrotic syndrome,and all were oral The amount of prednisone acetate tablets did not relieve after 2 weeks of proteinuria.According to the type of combined immunosuppressive agents,they were divided into 2 groups.35 cases of oral myeophenolate mofetil(MMF)15-20 mg/(kg.d)were observed before and 2 weeks and 4 weeks and 3 months after treatment,and the changes of various indicators were observed,including albumin,urea nitrogen,Serum creatinine,triglycerides,total cholesterol,24-hour urine protein quantification,urine protein/creatinine ratio,urine sediment microscopic examination of red blood cell count,observe adverse reactions during treatment,including infection,myelosuppression,renal dysfunction,gastrointestinal reaction Etc.to evaluate the treatment effect and safety.Results:After two weeks and four weeks of treatment,the 24-hour urine protein quantity of the two groups decreased,and the decrease degree of TAC group was more obvious,the difference was statistically significant(P<0.05).After 12 weeks of treatment,24-hour urinary protein,urinary protein/creatinine ratio,bun,SCR,TC,Tg of the two groups were significantly decreased compared with those before treatment,and the difference was not statistically significant(P>0.05).At 12 weeks after treatment,ALB of the two groups was increased,and the difference was not statistically significant(P>0.05).After 4 weeks and 12 weeks of treatment,the red blood cell count of urine sediment in the two groups were significantly reduced,and the reduction degree of MMF group was more obvious,the difference was statistically significant(P<0.05).There was no significant difference in the total effective rate between the two groups after treatment(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Mycophenolate mofetil and tacrolimus combined with glucocorticoid in the treatment of children with nephrotic syndrome purpura nephritis have obvious clinical efficacy.Compared with mycophenolate mofetil,tacrolimus reduced proteinuria more significantly after two weeks and four weeks of treatment,indicating that tacrolimus has a faster onset time on proteinuria.After 12 weeks of treatment,there was no difference between tacrolimus and mycophenolate mofetil in reducing proteinuria.After two weeks and twelve weeks of treatment,compared with tacrolimus,mycophenolate mofetil had earlier onset time and more obvious decrease in erythrocyte count of urinary sediment,which indicated that mycophenolate mofetil had better effect on hematuria.Tacrolimus and mycophenolate mofetil in the treatment of nephrotic syndrome type purpura nephritis,there are adverse reactions,but the incidence of adverse reactions is low,no serious adverse reactions occurred.