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羟氯喹联合血管紧张素转化酶抑制剂治疗儿童非大量蛋白尿IgA血管炎肾炎的疗效研究

Efficacy of hydroxychloroquine combined with angiotensin-converting enzyme inhibitor in treatment of non-massive proteinuria children with IgA vasculitis nephritis

    摘要
  • 摘要:
    目的 探讨羟氯喹(HCQ)联合血管紧张素转化酶抑制剂(ACEI)治疗儿童非大量蛋白尿免疫球蛋白A(IgA)血管炎肾炎(IgAVN)患儿的疗效。
    方法 收集2023年8月—2024年8月贵阳市妇幼保健院收治的42例非大量蛋白尿IgAVN患儿为研究对象, 分为ACEI组23例、ACEI联合HCQ组19例。比较2组治疗前后尿微量白蛋白水平、24 h尿蛋白、尿常规、不良反应、心电图、眼底检查结果。
    结果 治疗0.5、1、3、6个月时, 2组尿微量白蛋白、24 h尿蛋白、尿红细胞计数均呈下降趋势，差异有统计学意义(P < 0.05); 治疗3、6个月时, ACEI联合HCQ组尿微量白蛋白、24 h尿蛋白水平低于ACEI组，差异有统计学意义(P < 0.05); 治疗0.5、1、3、6个月时, ACEI联合HCQ组尿红细胞计数均低于ACEI组，差异均有统计学意义(P < 0.05)。ACEI联合HCQ组总缓解率为68.4%(13/19), ACEI组总缓解率为56.5%(13/23), 差异无统计学意义(P>0.05)。ACEI联合HCQ组发生恶心2例，肝功能异常1例，呼吸道感染1例，不良反应总发生率为21.1%(4/19); ACEI组发生恶心2例，头晕2例，肝功能异常1例，呼吸道感染2例，不良反应总发生率为30.4%(7/23); 2组不良反应总发生率比较，差异有统计学意义(P=0.029)。2组均无患儿发生心律失常、视网膜病变等严重不良反应事件。
    结论 HCQ联合ACEI治疗具有良好的抗尿蛋白作用，且安全性好。

     

    Abstract:
    Objective To investigate the efficacy of hydroxychloroquine (HCQ) combined with angiotensin-converting enzyme inhibitor (ACEI) in the treatment of children with non-massive proteinuria IgA vasculitis nephritis (IgAVN).
    Methods A total of 42 children with non-massive proteinuria IgAVN in the Guiyang Maternal and Child Healthcare Hospital from August 2023 to August 2024 were collected as the study subjects. They were divided into ACEI group (n=23) and ACEI combined with HCQ group (n=19). The urinary microalbumin level, 24-hour urinary protein, routine urinalysis, adverse reactions, electrocardiogram findings, and fundus examination results were compared between the two groups before and after treatment.
    Results At 0.5, 1, 3 and 6 months of treatment, the urinary microalbumin, 24-hour urinary protein, and urinary red blood cell counts in both groups showed significantly decreasing trend (P < 0.05). At 3 and 6 months of treatment, the urinary microalbumin and 24-hour urinary protein levels in the ACEI combined with HCQ group were significantly lower than those in the ACEI group (P < 0.05). At 0.5, 1, 3, and 6 months of treatment, the urinary red blood cell counts in the ACEI combined with HCQ group were significantly lower than those in the ACEI group (P < 0.05). The total remission rate was 68.4% (13/19) in the ACEI combined with HCQ group and 56.5% (13/23) in the ACEI group, with no significant between-group difference (P>0.05). In the ACEI combined with HCQ group, there were 2 cases of nausea, 1 case of abnormal liver function, and 1 case of respiratory tract infection, with a total incidence rate of 21.1% (4/19). In the ACEI group, there were 2 cases of nausea, 2 cases of dizziness, 1 case of abnormal liver function, and 2 cases of respiratory tract infection, with a total incidence rate of 30.4% (7/23). There was significant difference in the total incidence of adverse reactions between the two groups (P=0.029). No serious adverse events such as arrhythmia or retinopathy occurred in children in the two groups.
    Conclusion HCQ combined with ACEI treatment exhibits a favorable anti-urinary protein effect and good safety.

     

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