Comparison Of Efficacy Of Tacrolimus And Cyclophosphamide Combined With Glucocorticoid In Treatment Of Refractory Nephrotic Syndrome In Children

Objective:In this study,clinical data of tacrolimus and cyclophosphamide combined with glucocorticoid in the treatment of refractory nephropathy in children were retrospectively analyzed to compare the effects of tacrolimus and cyclophosphamide on immune function,efficacy,overall remission rate and incidence of adverse reactions.Methods:A total of 57 children with refractory nephrotic syndrome treated in a hospital from January 2016 to December 2020,on the basis of combined of glucocorticoid treatment,they were divided into tacrolimus group and cyclophosphamide group according to he addition of different immunosuppressants,and each group was divided into two subgroups before and after treatment:before and post-treatment group.The24-hour urinary protein quantity,plasma albumin,serum creatinine,total cholesterol,complement C3,immunoglobulin Ig G,CD4~+lymphocyte percentage,CD8~+lymphocyte percentage and CD4~+/CD8~+ratio were collected in two groups before tacrolimus or cyclophosphamide combined with glucocorticoids and after 6 months of treatment.The effects of immune function,efficacy,overall remission rate and incidence of adverse reactions before and after treatment were analyzed.Results:1.A total of 57 cases of refractory nephrotic syndrome were collected in this study.Including 38 cases in the tacrolimus group,including 20 males and 18 females;the clinical types were simple type in 33 cases and nephritis type in 5 cases;a total of 21 pathological examinations were performed,minimal change disease(MCD) was reported in 5 cases,focal segmental glomerulo sclerosis(FSGS)in 1 case and podiatocytic disease(not excluded FSGS)in 15 cases;They ranged from 1 year old to 15 years old,with an average age of(6.45±3.53)years old.There were 19 cases in cyclophosphamide group,including 10 males and 9 females;the clinical types were simple type 10 cases and nephritis type 9 cases;a total of 16 pathological examinations were performed,minimal lesion type(MCD)was reported in 6 cases,podiatocytic disease(not excluded FSGS)in 1 case,Mesangial proliferative glomerulo nephritis(Ms PGN)in 2 cases and Ig A nephropathy in 7 cases;The average age was(6.90±4.09)years,ranging from 2 to 14 years.2.Before treatment,the levels of albumin,serum creatinine,total cholesterol and24-hour urinary protein in tacrolimus group and cyclophosphamide group were similar(P>0.05);After treatment,there was no significant difference among the four groups(P>0.05).Compared with before treatment,24-hour urinary protein decreased(P<0.05),albumin increased(P<0.05),total cholesterol decreased(P<0.05),and serum creatinine did not change significantly in tacrolimus group and cyclophosphamide group.3.There were no significant differences in serum Ig G,complement C3,CD4~+,CD8~+,CD4~+/CD8~+before treatment between tacrolimus group and cyclophosphamide group(P>0.05).After treatment,CD4~+and CD4~+/CD8~+in tacrolimus group were higher than those in cyclophosphamide group(P<0.05),and CD8~+was lower than that in cyclophosphamide group(P<0.05).Compared with before treatment,blood Ig G,complement C3,CD4~+and CD4~+/CD8~+increased after treatment in tacrolimus group and cyclophosphamide group,while CD8~+decreased.4.After 6 months of treatment,the overall response rate in the tacrolimus group was higher than in the cyclophosphamide group,but the difference was not statistically significant(P>0.05).5.The incidence of adverse reactions was higher in the cyclophosphamide group than in the tacrolimus group(P<0.05).Conclusions:1.The efficacy of tacrolimus or cyclophosphamide combined with glucocorticoid in children with refractory nephrotic syndrome is comparable;2.Tacrolimus has less effect on immune function in children compared with cyclophosphamide;3.There was no significant difference in overall response rates between tacrolimus and cyclophosphamide in refractory nephrotic syndrome,but the incidence of adverse reactions was lower.