霉酚酸酯联合α-干扰素治疗儿童乙型肝炎相关性肾炎的临床研究  

Clinical Study of Mycophenolate Mofetil Combined with Interferon-α Treating Children with Refractory HBV-associated Nephritis

作　　者：傅元凤[1] 封志纯[1] 刘光陵[2] 伏洁[2] 

机构地区：[1]南方医科大学附属珠江医院儿科,广东省广州市510282 [2]南京军区总医院儿科

出　　处：《中国全科医学》2006年第20期1714-1715,共2页Chinese General Practice

摘　　要：目的观察霉酚酸酯联合α-干扰素对难治性乙型肝炎相关性肾炎的治疗效果及对体内乙型肝炎病毒复制的影响。方法临床表现为大量蛋白尿、HBsAg(+)、HBeAg(+)、抗HBc(+)并有轻度肝功能异常,经肾组织活检确诊为乙型肝炎相关性肾炎,并在外院经足量泼尼松治疗8周无效的6例患儿,给予霉酚酸酯800～1000mg.m-2.d-1,6个月后减半再服用3个月,α-干扰素100万U/次,3次/周,连用6个月。结果6例患儿尿蛋白在用药后1～3个月转阴,原轻度增高的转氨酶恢复正常。6个月后复查血清乙型肝炎标记物及HBV-DNA,其中4例患儿HBsAg、HBeAg、抗HBc均转阴,HBV-DNA<0.001copies/ml,另2例血清HBsAg、HBeAg、抗HBc仍然阳性,HBV-DNA数目无明显变化。随访10～42个月,5例患儿尿蛋白持续阴性。结论霉酚酸酯联合α-干扰素有可能是治疗乙型肝炎相关性肾炎的有效方法,特别是当传统治疗无效、乙型肝炎病毒复制活跃及转氨酶升高时,霉酚酸酯更显其优越性。Objective To observe the curative effects of mycophenolate mofetil （MMF） combined with interferon -α （ IFN -α） treating HBV - associated nephritis and the influence of MMF on replication of HBV. Methods Six children with proteinuria （protein output 〉50mg· kg^-1·24h^-1）, HBsAg （＋）, HBeAg （＋）, anti-HBc （＋）, slight liver dysfunction and prednisone （2 mg · kg^-1· d^ -1 for 8 weeks） treatment failure in other hospitals were finally diagnosed as HBV - associated nephritis by renal biopsy, then they were treated with MMF 800 - 1000 mg ·m^-2 · d^-1 for six months and then 500 mg · m^-2 ·d^-1 for three months combined with interferon - α 1 MU, three times a week for six months. Results Proteinuria of all patients became negative after one to three months and the heightened serum aminotransferase level decreased to normal level. Six months later, serum HBsAg, HBeAg and anti - HBc became negative and HBV - DNA couldn＇t be detected in four of these children. However, serum HBsAg, HBeAg and anti - HBc were still positive in another two children and HBV - DNA had no distinguished change. Proteinuria kept negative in five children for 10 -42 months. Conclusion Mycophenolate mofetil combined with interferon - α may be an efficient therapy for HBV - associated nephritis, especially when the patients are refractory to the traditional therapy, and HBV - DNA is actively copied and aminotransterase rise.

关 键 词：乙型肝炎相关性肾炎 霉酚酸酯 Α-干扰素 儿童 

分 类 号：R726.923[医药卫生—儿科] R725.126.2[医药卫生—临床医学]