环磷酰胺连续冲击治疗壮族儿童难治性肾病综合征疗效及远期随访  

Long-Term Following Up and Curative Effect of Continuous Stosstherapy with Cyclophosphamide in Treatment of Refractory Nephrotic Syndrome in Children in Zhuang Nationality

作　　者：刘运广[1] 林娜[1] 李强[1] 黄月艳[1] 汤茜[1] 

机构地区：[1]右江民族医学院附属医院儿科,广西百色533000

出　　处：《实用儿科临床杂志》2006年第18期1260-1262,共3页Journal of Applied Clinical Pediatrics

基　　金：广西自然科学基金项目资助(桂科自0229061);广西科学研究与技术开发项目资助(桂科基0141025)

摘　　要：目的探讨大剂量环磷酰胺（CTX）冲击治疗壮族儿童难治性肾病综合征（肾病）的疗效及远期对性腺的损害。方法对38例壮族难治性肾病综合征患儿予CTX8～12mg／（k·d）加入生理盐水或10％葡萄糖注射液100mL，静滴1h左右，1次／d，连用8～10次，累积量〈80～120mg／kg。同时应用泼尼松2mg／（kg·d）。结果1．临床治愈28例（73．6％），完全缓解7例（18．42％），部分缓解2例（5．26％），死亡1例（2．63％），疗效与临床分类、病理类型关系不明显（P均〉0．05）；2．冲击治疗后d2血浆总蛋白、清蛋白较治疗前明显提高（P〈0．01），第4周已达正常水平（P〈0．01）；24h尿蛋白明显降低（P〈0．01）；血胆固醇冲击结束后4周明显降低（P〈0．01），血肌苷、Hb、WBC、PLT治疗前后均无明显改变（P均〉0．05）。3．不良反应：20例（52．63％）有胃肠道反应，2例（5．26％）WBC减少，38例（100．0％）脱发，1例（2．63％）有心脏损害。CTX冲击治疗时年龄≥8岁、临床治愈、末次随访年龄≥17岁的18例精液检查或月经来潮正常，已婚7例男女均已生育。结论CTX连续冲击联合泼尼松治疗壮族儿童难治性。肾病疗效好，可快速提高血浆总蛋白、清蛋白水平，尿蛋白转阴快。CTX累积总量小于80mg／kg，近期安全，远期未发现性腺损害。Objective To explore the curative effect and long - term sexual gland impairment of continuous stosstherapy with a large dose of cyclophosphamide （CTX） in treatment of nephrotic syndrome（NS） in children in Zhuang nationality. Methods CTX was given to 38 children with refractory NS in Zhuang nationality. The usage of CTX as followed： 8 - 12 mg/kg CTX and sodium chloride injection （or 10% glucose injection） 100 mL were given by intravenous drip for about 1 hour once a day, and last 8 - 10 days, the accumulated amount of CTX was less than 80 - 100 mg/kg. Prednisone was given 2 mg/（kg· d）at the same time. Results 1. Of 38 cases, 28 were clinically cured （73.65%）, 7 complete remission （ 18.42% ） ; 2 partially remission（5.26% ） and 1 died （2.63%）. No obvious relationship could be seen between curative effect and clinical classification or pathological types （all P 〉 0.05 ）. 2. Two days after treatment, total protein （TP） and albumin （Alb） of hemotoplasrna were significantly higher than before treatment （all P〈0.01 ） ; TP and Alb turned to normal level （ P〈0.01 ） after 4 weeks, and total urine protein of 24 hours was decreased obviously （ P〈0.01 ）. Blood cholesterol had a significant reduction in 4 weeks after finishing treatment. Blood inosine, hemoglobin（IAb）, white blood cell （WBC） and blood platelet （PLT） had no changes before and after treatment （all P 〉0.05）. 3. Toxic side effects： gastrointestinal reaction was seen in 20 cases （52.63%）, reduction of WBC in 2 eases （5.26%）, baldness in 38 cases （ 100% ） and heart impairment in 1 case （2.63%）. The sperm test and menstrual onset were normal in 18 cases, whose ages≥ 8 years at beginning of treatment, who were clinically cured and whose ages ≥17 years at the time of last following up, 7 of them who had married could have children. Conclusions Combining CTX continuous stosstherapy with prednisone standard scheme treated the children in Zhuang nationality with NS,

关 键 词：肾病综合征 环磷酰胺 壮族 儿童 

分 类 号：R726.9[医药卫生—儿科]