甲基泼尼松龙冲击疗法治疗小儿肾病综合征复发疗效观察  

Retrospective analysis of pulse methylprednisolone therapy in children with steroid-sensitive relapsing nephrotic syndrome

作　　者：张焱[1] 黄建萍[1] 肖慧捷[1] 丁洁[1] 姚勇[1] 杨霁云[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《临床儿科杂志》2007年第4期274-277,共4页Journal of Clinical Pediatrics

基　　金：北京大学"211"工程循证医学学科群课题(No.91000-246156065)

摘　　要：目的初步分析甲基泼尼松龙冲击治疗激素敏感的原发性肾病综合征的疗效和不良反应。方法对2000～2004年应用甲基泼尼松龙冲击治疗的激素敏感的11例原发性肾病综合征住院患儿临床资料进行回顾性分析,并与既往相似情况下口服足量泼尼松治疗的效果进行自身对照分析。结果11例中男9例,女2例;甲基泼尼松龙冲击时年龄3～12岁,平均(7.5±3.1)岁;病程3～38个月,平均(15.1±10.4)个月;3例为不频复发,8例为频复发。甲基泼尼松龙冲击治疗1疗程后11例中尿蛋白转阴10例,尿蛋白转阴时间为1～18d,平均(7.4±4.4)d;其中7例较口服足量泼尼松治疗尿蛋白转阴的时间缩短,但对前后2次复发时病情基本相同的6例患儿尿蛋白转阴时间进行配对样本t检验,差异无统计学意义。甲基泼尼松龙冲击治疗期间,出现不良反应6例。结论与口服足量泼尼松治疗相比,甲基泼尼松龙冲击治疗对小儿激素敏感的原发性肾病综合征的疗效尚待定论,且治疗期间可能出现不良反应,需慎重使用,其有效性及安全性有待进一步作前瞻性随机对照研究证实。Objectives To study retrospectively the effectiveness and adverse effects of pulse methylprednisolone therapy （PMT） in children with idiopathic nephrotic syndrome. Methods A retrospective study of 11 cases of steroidsensitive relapsing nephrotic syndrome which received PMT over a 5-year period （from 2000 to 2004） was performed. All of them had been treated with oral prednisone in similar condition previously. A self-control design was used to compare the effects of PMT with oral prednisone. Results The average age of the 11 cases was 7.5± 3.1 years and the average course of disease was 15.1 ± 10.4 months. Relapses were frequent in 8 cases. Ten cases achieved complete remission after the first course of PMT, and the average duration of PMT therapy until remission was 7.4 ± 4.4 days. One case attained complete remission after the second course of PMT. Compared with the effect of oral prednisone previously, 7 cases attained complete remission more rapidly. Paired samples t-test was performed to compare the effect of PMT and oral prednisone in 6 cases with very similar conditions, but no statistical difference was detected. During PMT treatment, adverse effects were found in 6 cases. Conclusions Compared with oral prednisone, the superiority of PMT in children with steroid-sensitive nephrotic syndrome had not been confirmed, and some adverse effects have not been eliminated during the treatment. Therefore, we should be very careful when administering PMT in patients. A prospective clinical randomized controlled trial will be necessary to further evaluate the effectiveness of PMT.

关 键 词：肾病综合征 甲基泼尼松龙冲击治疗 儿童 

分 类 号：R726.9[医药卫生—儿科]