|本期目录/Table of Contents|

[1]张沛,周昱,高春林,等.咪唑立宾联合糖皮质激素治疗儿童IgA肾病的临床研究[J].医学研究与战创伤救治(原医学研究生学报),2022,24(4):356-361.[doi:10.3969/j.issn.1672-271X.2022.04.005]
　ZHANG Pei,ZHOU Yu,GAO Chun-lin,et al.Clinical research of mizoribine in the treatment of children with IgA nephropathy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(4):356-361.[doi:10.3969/j.issn.1672-271X.2022.04.005]
点击复制

咪唑立宾联合糖皮质激素治疗儿童IgA肾病的临床研究()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年4期
页码:
356-361
栏目:
临床研究
出版日期:
2022-08-30

文章信息/Info

Title:
Clinical research of mizoribine in the treatment of children with IgA nephropathy
作者:
张沛; 周昱; 高春林; 夏正坤
作者单位：210002南京，南京大学医学院附属金陵医院（东部战区总医院）儿科（张沛、周昱、高春林、夏正坤）
Author(s):
ZHANG Pei;  ZHOU Yu;  GAO Chun-lin;  XIA Zheng-kun
(Department of Paediatrics, Jinling Hospital, Nanjing University School of Medicine/General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
咪唑立宾; IgA肾病; 儿童; 临床研究
Keywords:
mizoribine;  IgAN;  children;  clinical research
分类号:
R726.9；R692.31
DOI:
10.3969/j.issn.1672-271X.2022.04.005
文献标志码:
A
摘要:
目的探讨咪唑立宾（MZR）治疗儿童IgA肾病（IgAN）的疗效与安全性。方法选择2016年1月至2018年12月东部战区总医院儿科收治的儿童IgAN46例，根据治疗方法不同，按照随机数字法分为强的松（PDN）与MZR联合治疗组（联合组，n=24）和PDN单药治疗组（单药组，n=22）。分析2组患儿随访3个月、6个月、12个月和24个月的实验室检查结果、预后和不良反应。结果联合组12个月和24个月ALB水平高于基线值（P<0.05）；单药组24个月白蛋白（ALB）水平高于基线值（P<0.05）；联合组12个月和24个月尿蛋白定量水平低于基线值（P<0.05，P<0.01）；单药组24个月尿蛋白定量水平低于基线值（P<0.05，P<0.01）；联合组6个月、12个月和24个月尿N-乙酰-β-D-葡萄糖苷（NAG）酶水平低于基线值（P<0.01）；单药组12个月和24个月尿NAG酶水平低于基线值（P<0.05，P<0.01）；联合组12个月和24个月尿视黄醇结合（RB）蛋白水平低于基线值（P<0.05，P<0.01）；单药组24个月尿RB蛋白水平低于基线值（P<0.01）。主要终点预后：24个月随访结束，联合组总体预后（91.67%）高于单药组（68.18%,P<0.05），无一例达到次要终点。联合组呼吸道感染次数（54.17%）的比例高于单药组（22.73%,P<0.05），联合组病情复发次数（12.50%）低于单药组（50.00%,P<0.05）。联合组蛋白消失比例明显高于单药组（P<0.05），激素累积剂量低于单药组[(2.45±0.61）mg/dvs （3.12±0.74）mg/d，P<0.05]。结论MZR联合PDN治疗儿童IgAN有效性和安全性较高，临床效果高于单药PDN，且长期预后好于单药PDN治疗。
Abstract:
ObjectiveTo investigate the efficacy and safety of mizoribine (MZR) in children with IgA nephritis (IgAN).MethodsFrom January 2016 to December 2018, 46 cases of children IgAN admitted to the Department of Paediatrics of Jinling Hospital were analyzed. According to treatment, all patients were divided into prednisone (PDN) and MZR combined treatment groups (PDN+MZR group, n=24) and PDN monotherapy group (PDN group, n=22). The laboratory tests of 3month (M), 6M, 12M and 24M follow-up time, prognosis and adverse reactions of the two groups of children were analyzed.ResultsAt the follow-up time of 12M and 24M, the albumin (ALB) levels in PDN+MZR group were higher than baseline (P<0.05). At 24M time, the ALB levels in PDN group were higher than baseline (P<0.05). At 12M and 24M time, urine protein level in PDN+MZR group were lower than baseline (P<0.05, P<0.01). At 24M time, urine protein level in PDN group were lower than baseline (P<0.05, P<0.01). At 6M, 12M and 24M time, the urinary NAG enzyme level in PDN+MZR group were lower than baseline (P<0.01). At 12M and 24M time, the urinary NAG enzyme level in PDN group were lower than baseline (P<0.05, P<0.01). At 12M and 24M time, the urinary RB protein levels in PDN+MZR group were lower than baseline (P<0.05, P<0.01). At 24M time, the urine RB protein level in the PDN group was lower than baseline (P<0.01). Primary end-point prognosis: at the time of 24M follow-up, the overall prognosis of PDN+MZR group (91.67%) was higher than PDN group (68.18%, P<0.05). And none of the patients reached the secondary end-point. The proportion of respiratory infections in PDN+MZR group (54.17%) was higher than that of the PDN group (22.73%, P<0.05). And the number of recurrences in PDN+MZR group (12.50%) was lower than that of the PDN group (50.00%, P<0.05). The proportion of proteinwas significantly higher than that in the PDN group (P<0.05). And the cumulative dose of glucocorticoid in the PDN+MZR group was lower than PDN group [(2.45±0.61）mg/d vs （3.12±0.74）mg/d，P<0.05].ConclusionMZR combined with PDN shows high efficacy and safety in the treatment IgAN children, the clinical effect is higher than single-agent PDN, and the long-term prognosis is better than single-agent PDN.

参考文献/References:

[1]Coppo R. Clinical and histological risk factors for progression of IgA nephropathy: an update in children, young and adult patients[J]. J Nephrol，2017，30(3): 339-346.
[2]Cambier A，Gleeson PJ， Flament H，et al. New therapeutic perspectives for IgA nephropathy in children[J]. Pediatr Nephrol，2021，36(3): 497-506.
[3]Huang C，Li X，Wu J，et al. The landscape and diagnostic potential of T and B cell repertoire in Immunoglobulin A Nephropathy[J]. J Autoimmun，2019, 97:100-107.
[4]吴和燕，高春林，夏正坤. IgA肾病特异性生物标志物的研究进展[J]. 医学研究生学报，2019，32(9): 994-998.
[5]中华医学会儿科学分会肾脏学组. 原发性IgA肾病诊治循证指南(2016)[J]. 中华儿科杂志，2017，55(9): 643-646.
[6]Xia ZK, Gao YF, Rong LP, et al. Usefulness of mizoribine administration in children with frequently relapsing nephrotic syndrome, and the relationship between pharmacokinetic parameters and efficacy: a multicenter prospective cohort study in China[J]. World J Pediatr，2019，15(3)：262-269.
[7]Berger J, Hinglais N. Intercapillary deposits of IgA-IgG[J]. J Urol Nephrol(Paris)，1968，74(9): 694-695.
[8]Shen H，Gu W，Mao J，et al. Clinical characteristics of concomitant nephrotic IgA ne-phropathy and minimal change disease in children[J]. Nephron，2015，130(1): 21-28.
[9]Wenderfer SE, Gaut JP. Glomerular diseases in children[J]. Adv Chronic Kidney Dis，2017，24(6): 364-371.
[10]Santangelo L，Netti GS，Giordano P，et al. Indications and results of renal biopsy in children: a 36-year experience[J]. World J Pediatr，2018，14(2):127-133.
[11]Dyga K, Szczepańska M. IgA vasculitis with nephritis in children[J]. Adv Clin Exp Med，2020，29(4):513-519.
[12]Hu S，Birg A，Hovaida M，et al. Avoiding "Rash" Conclusions: Challenge of IgA Vasculitis in Adults[J]. Dig Dis Sci，2017，62(4):874-878.
[13]Coppo R. Pediatric IgA nephropathy in Europe[J]. Kidney Dis(Basel)，2019，5(3): 182-188.
[14]Coppo R, Robert T.IgA nephropathy in children and in adults two separate entities or the same disease[J]. J Nephrol，2020，33(6):1219-1229.
[15]Cambier A，Rabant M，Peuchmaur M，et al. Immunosuppressive treatment in children with IgA nephropathy and the clinical value of podocytopathic features[J]. Kidney Int Rep，2018，3(4): 916-925.
[16]Okpechi IG，Ameh OI，Bello AK，et al. Epidemiology of histologically proven glomerulonephritis in Africa: a systematic review and meta-analysis[J]. PLoS One，2016，11(3): e0152203. doi: 10.1371/journal.pone.0152203.
[17]Nie S，He W，Huang T，et al. The spectrum of biopsy-proven glomerular diseases among children in China: a national, cross-sectional survey[J]. Clin J Am Soc Nephrol，2018，13(7):1047-1054.
[18]Sugiyama H，Yokoyama H，Sato H，et al. Japan Renal Biopsy Registry and Japan Kidney Disease Registry: committee report for 2009 and 2010[J]. Clin Exp Nephrol，2013，17(2):155-173.
[19]Cho BS，Hahn WH，Cheong HI，et al. A nationwide study of mass urine screening tests on Korean school children and implications for chronic kidney disease management. Clin Exp Nephrol，2013，17(2):205-210.
[20]王心，陈铖. 伴高尿酸血症的原发性IgA肾病的临床及病理特征分析[J]. 东南国防医药，2017，19(6)：600-603.
[21]Floege J, Barbour SJ, Cattran DC,et al. Management and treatment of glomerular diseases(part 1): conclusions from a Kidney Disease: Improving Global Outcomes(KDIGO) Controversies Conference[J]. Kidney Int，2019，95(2): 268-280.
[22]Huang Y, Han M, Yang D, et al. Comparative Study of Mizoribine and Mycophenolate Mofetil Combined with a Calcineurin Inhibitor-Based Immunosuppressive Regimen in Patients with Alternative Donor Hematopoietic Cell Transplantation[J]. Biol Blood Marrow Transplant，2020，26(9): 1663-1669.
[23]Kondoh T, Ikezumi Y, Yokoi K, et al. Assessment of factors associated with mizoribine responsiveness in children with steroid-dependent nephrotic syndrome[J]. Clin Exp Nephrol，2019，23(9): 1154-1160.
[24]Kurokawa Y, Koike K, Kaida Y,et al. Effectiveness of cryofiltration and mizoribine combination with oral steroid therapy in a patient with membranoproliferative glomerulonephritis due to essential cryoglobulinemia[J]. CEN Case Rep，2019，8(3): 205-211.
[25]Takeuchi T, Okada K, Yoshida H,et al. Post-marketing surveillance study of the long-term use of mizoribine for the treatment of lupus nephritis: 2-Year results[J]. Mod Rheumatol，2018，28(1):85-94.
[26]Oda K, Mori N, Okumi M，et al. Uptake and metabolism of mizoribine, an immunosuppressant, in L5178Y-R mouse lymphoma cells in vitro and peripheral blood mononuclear cells of rats and kidney transplant recipients in vivo[J]. Drug Metab Pharmacokinet，2018，33(5): 232-239.
[27]Li SF, Gong MJ, Sun YF，et al. In Vitro and in Vivo Antiviral Activity of Mizoribine Against Foot-And-Mouth Disease Virus[J]. Molecules，2019，24(9): 1723.
[28]Yi Shi，Hang Liu，Xin-Guo Chen，et al. Hyperuricemia in Living Donor Kidney Transplantation Patients During Mizoribine Administration Caused Mainly by Changes in Kidney Function[J]. Transplant Proc，2019，51(5): 1392-1396.

相似文献/References:

[1]杨 黄.IgA肾病患者血压节律和血浆B型钠尿肽变化的临床价值[J].医学研究与战创伤救治(原医学研究生学报),2013,15(04):349.[doi:10.3969/j.issn.1672-271X.2013.04.010]
　YANG Huang.The clinical value of blood pressure rhythm and plasma B-type natriuretic peptide in patients with IgA nephropathy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2013,15(4):349.[doi:10.3969/j.issn.1672-271X.2013.04.010]
[2]王心,陈铖.伴高尿酸血症的原发性IgA肾病的临床及病理特征分析[J].医学研究与战创伤救治(原医学研究生学报),2017,19(06):600.[doi:10.3969/j.issn.1672-271X.2017.06.010]
　WANG Xin,CHEN Cheng.The clinical and pathological features of primary IgA nephropathy with hyperuricemia[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2017,19(4):600.[doi:10.3969/j.issn.1672-271X.2017.06.010]
[3]黄海,列才华,梁兰青,等.细胞因子对IgA肾病患者IgA1 O-糖基化的影响及相关机制研究[J].医学研究与战创伤救治(原医学研究生学报),2019,21(01):44.[doi:10.3969/j.issn.1672-271X.2019.01.010]
　HUANG Hai,LIE Cai-hua,LIANG Lan-qing,et al.Effects of cytokines on IgA1 O-glycosylation in IgAN and its related mechanisms[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(4):44.[doi:10.3969/j.issn.1672-271X.2019.01.010]
[4]张沛,周昱,何旭,等.咪唑立宾治疗儿童紫癜性肾炎的疗效与安全性[J].医学研究与战创伤救治(原医学研究生学报),2022,24(1):6.[doi:10.3969/j.issn.1672-271X.2022.01.002]
　ZHANG Pei,ZHOU Yu,HE Xu,et al.Effect and safety of mizoribine on Henoch-Schnlein purpura nephritis in children[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(4):6.[doi:10.3969/j.issn.1672-271X.2022.01.002]

备注/Memo

备注/Memo:
基金项目：江苏省自然科学基金（BK20190251）；中国博士后基金资助项目（2018M643888）
更新日期/Last Update: 2022-09-06