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目的研究糖皮质激素(GC)对原发性肾病综合征(PNS)患者白细胞的影响,探讨白细胞变化和疗效的关系。方法回顾性分析2010年12月至2016年7月在徐州医学院附属医院初诊为PNS 60例患者的临床资料。结果 (1)GC治疗前,与对照组比较,疗效好组中性粒细胞、嗜酸性粒细胞、中性粒细胞与淋巴细胞的比值(NLR)明显升高,疗效差组白细胞总数、中性粒细胞、单核细胞、NLR明显升高;与疗效差组比较,疗效好组嗜酸性粒细胞明显升高,差异有统计学意义(P<0.05)。(2)GC治疗后,与对照组比较,疗效好组和疗效差组白细胞总数、中性粒细胞、淋巴细胞、单核细胞、NLR均明显升高,疗效好组嗜酸性粒细胞明显减少,差异有统计学意义(P<0.05);与疗效差组比较,疗效好组各类白细胞和NLR差异无统计学意义(P>0.05)。(3)疗效好组治疗后比治疗前白细胞总数、中性粒细胞、淋巴细胞、单核细胞、NLR明显升高,嗜酸性粒细胞明显减少,差异有统计学意义(P<0.05)。疗效差组治疗后比治疗前白细胞总数、中性粒细胞、淋巴细胞、单核细胞、嗜碱性粒细胞明显升高,嗜酸性粒细胞明显减少,差异有统计学意义(P<0.05)。结论 GC短期内不能完全抑制PNS患者的炎症反应。GC可导致PNS患者血白细胞总数、中性粒细胞、淋巴细胞、单核细胞明显升高,但与疗效无关。嗜酸性粒细胞可以作为预测GC疗效的指标。GC对IMN疗效不好,对MCD和MsPGN疗效差异不大。
Objective To investigate the effect of glucocorticoid (GC) on leukocytes in patients with primary nephrotic syndrome (PNS) and to explore the relationship between leukocyte changes and therapeutic efficacy. Methods The clinical data of 60 newly diagnosed PNS patients in Xuzhou Medical College Affiliated Hospital from December 2010 to July 2016 were retrospectively analyzed. Results (1) Before treatment with GC, compared with the control group, the effective group neutrophil, eosinophil, neutrophil and lymphocyte ratio (NLR) was significantly increased, the poor efficacy of the total number of leukocytes, neutral Granulocytes, monocytes, NLR increased significantly; compared with the poor efficacy group, the effective group eosinophils increased significantly, the difference was statistically significant (P <0.05). (2) Compared with the control group, the total number of leukocytes, neutrophils, lymphocytes, monocytes and NLR in the group with good curative effect and the group with poor curative effect were significantly increased after GC treatment. The eosinophils with good curative effect were significantly reduced, The difference was statistically significant (P <0.05). Compared with the poor efficacy group, there was no significant difference between the various types of white blood cells and NLR (P> 0.05). (3) The curative effect was better than that before treatment, the total number of leukocytes, neutrophils, lymphocytes, monocytes, NLR increased significantly and eosinophils decreased significantly after treatment (P <0.05). The total number of leukocytes, neutrophils, lymphocytes, monocytes, basophils and eosinophils in the poor-effect group after treatment were significantly higher than those before treatment (P <0.05). Conclusion GC can not completely inhibit the inflammatory reaction in PNS patients in short term. GC can lead to PNS patients the total number of white blood cells, neutrophils, lymphocytes, monocytes significantly increased, but with no effect. Eosinophils can be used as an indicator of GC efficacy. The effect of GC on IMN is not good, and the effect on MCD and MsPGN is not obvious.