摘要
目的探讨他克莫司联合恩替卡韦治疗肾病综合征合并乙肝患者的疗效及其对血管生成素样蛋白-4(Angptl4)、24 h蛋白尿和谷丙转氨酶(GPT)的影响。方法前瞻性分析2016年1月至2021年1月在本院收治的85例肾病综合征合并乙肝患者,采用数字表法将患者分为对照组(43例)和研究组(42例)。对照组接受他克莫司治疗,研究组接受他克莫司联合恩替卡韦治疗,对比两组患者的疗效。结果研究组的总有效率高于对照组(95.24%vs.79.07%,P=0.026)。治疗前,两组患者的GPT、碱性磷酶(ALP)、谷氨酰转肽酶(GGT)、血清血糖、白蛋白、24 h蛋白尿、血清Angptl4、Th17、Th1、血清T淋巴细胞亚群水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者的GPT、血清血糖、24 h蛋白尿、血清Angptl4、Th17、Th1、CD4^(+)水平低于治疗前(均P<0.05),而ALP、谷氨酰转肽酶(GGT)、白蛋白、CD8^(+)水平高于治疗前(均P<0.05),且对照组CD4^(+)/CD8^(+)水平低于治疗前(均P>0.05)。研究组治疗后的ALP、GGT、白蛋白、血清血糖、血清CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,GPT、24 h蛋白尿、血清Angptl4、Th17、Th1、CD8^(+)低于对照组(均P<0.05)。两组的不良反应比较,差异无统计学意义(9.30%vs.7.14%,χ^(2)=0.298,P=0.585)。结论他克莫司联合恩替卡韦治疗肾病综合征合并乙肝,能改善患者的T淋巴细胞亚群和肝肾功能、降低Angptl4水平,且安全性较好。
Objective To investigate the efficacy of tacrolimus combined with entecavir in the treatment of patients with nephrotic syndrome with hepatitis B and its effect on angiopoietin like protein-4(Angptl4),24-hour proteinuria and glutamic pyruvic transaminase(GPT).Methods From January 2016 to January 2021,85 patients with nephrotic syndrome complicated with hepatitis B were prospectively analyzed in our hospital.The patients were divided into control group(43 cases)and study group(42 cases)by using the number table method.The control group received tacrolimus treatment,and the research group received tacrolimus combined with entecavir treatment.The efficacy of the two groups of patients was compared.Results The significant efficiency and effective rate of the study group were 66.67%(28 cases)and 28.57%(12 cases),respectively,while those of the control group were 48.84%(21 cases)and 30.23%(13 cases).The total effective rate of the study group was higher than that of the control group(95.24%vs.79.07%,P=0.026).Before treatment,there were no statistically significant differences in the levels of GPT,ALP,GGT,serum blood glu-cose,albumin,24-hour proteinuria,Angptl4,Th17,Th1,and serum T lymphocyte subsets between the two groups(all P>0.05).After treatment,the levels of GPT,serum blood glucose,24-hour proteinuria,Angptl4,Th17,Th1 and CD4^(+)in the two groups were lower than those before treatment,while the levels of ALP,GGT,albumin and CD8^(+)were higher than those before treatment,and the level of CD4^(+)/CD8^(+)in the control group was lower than that before treatment(all P>0.05).After treatment,ALP,GGT,albumin,serum CD4^(+),CD4^(+)/CD8^(+)levels in the study group were higher than those in the control group,and GPT,serum blood glucose,24-hour proteinuria,serum Angptl4,Th17,Th1,CD8^(+)were lower than those in the control group(all P<0.05).There was no significant difference in adverse reactions between the two groups(χ^(2)=0.298,P=0.585).Conclusions Tacrolimus combined with entecavir in the treatment of nephrotic syndrome complicated with hepatitis B can effectively improve the T lymphocyte subsets of patients,improve liver and kidney function,reduce the level of Angptl4,and has good safety.
作者
谢依嶷
赵志权
宁燕虹
李绍兰
Xie Yiyi;Zhao Zhiquan;Ning Yanhong;Li Shaolan(Department of Nephrology,Nanning Second People′s Hospital,Nanning 530000,China)
出处
《国际泌尿系统杂志》
2023年第3期399-403,共5页
International Journal of Urology and Nephrology
基金
广西壮族自治区卫健委自筹经费科研项目 (Z20210140)。
