环孢素治疗儿童难治性肾病综合征的疗效  

Effect of Ciclosporin Treatment on Refractory Nephrotic Syndrome in Children

作　　者：李明[1] 蒋小云[1] 陈慧卿[1] 庄晓慧[2] 莫樱[1] 

机构地区：[1]中山大学附属第一医院儿科 [2]广东省人民医院儿科,广州510080

出　　处：《实用儿科临床杂志》2009年第17期1359-1361,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的观察环孢素(CsA)治疗儿童难治性肾病综合征(NS)的疗效。方法55例难治性NS患儿。其中激素依赖型NS(SDNS)3例,激素抵抗型NS(SRNS)22例,频反复型NS(FRNS)30例,联合使用CsA[3～5 mg/(kg.d)]和泼尼松治疗,维持其血药质量浓度在100～200 ng/L,疗程10个月,减量4个月。测定CsA治疗前后难治性NS患儿血Scr、BUN、Alb、ALT、Ccr、Chol水平、24 h尿蛋白定量,观察CsA不良反应。应用SPSS13.0软件进行统计学分析。结果41例(74.5%)患儿获完全缓解,6例(10.9%)部分缓解,总有效率达85.5%。其中单纯型缓解率达97.6%,肾炎型缓解率为50.0%;SDNS及FRNS组缓解率均为100%,SRNS组仅为63.6%;病理类型为微小病变(MCD)缓解率为100.0%,系膜增生性肾炎(MsPGN)、局灶性节段性肾小球硬化(FSGS)组缓解率分别为60.0%、42.9%。15例(31.9%)患儿在治疗减量过程中反复。CsA治疗过程未出现明显肾毒性反应,55例患儿均有毛发增多,16例出现齿龈增生,9例出现高血压,8例有胃肠道反应。本组未见明显肾功能损害。结论CsA是治疗儿童难治性NS有效且安全的药物,尤其是对SDNS、FRNS和病理表现为MCD的患儿有较好的疗效。Objective To observe the effect of ciclosporin（CsA） treatment on children with refractory nephrotic syndrome （NS）. Methods Combination treatment of CsA [ 3 -5 mg/（ kg· d） ] and prednisone were given 55 cases with refractory NS,in which including steroid - dependent NS （SDNS） 3 cases, steroid - resistant NS （ SRNS ） 22 cases, frequent - relapses NS （ FRNS ） 30 cases. Concentration of CsA was maintained 100 - 200 ng/L. Course of treatment was 10 months, the dose was tapered gradually in 4 months. Scr, BUN, Alb, ALT, Ccr, Chol,24 hours urine protein quantitation was measured before and after CsA treatment. Side effect of CsA was observed at the same time. SPSS 13.0 software was used to analyze the data. Results Forty - one cases （74.5%） were complete remission,6 cases （ 10.9% ） were partial remission,total effective rate was 85.5%. Remission rate was 97.6% in simple type NS,50.0% in nephritis type NS, 100% in SDNS and FRNS groups,63.6% in SRNS group. In group minimal change disease（MCD） ,the remission rate was 100.0% ,while 60.0% in group mesangial prolife-rative glomerulonephritis （ MsPGN）, and 42.9% in group focal segmental glomerulosclerosis （FSGS）. Fifteen cases （31.9% ） relapsed when the dose of CsA was tapering. The adverse effects included hairincss （55 cases） ,gum hypertrophy （16 cases） ,hypertensian（9 cases）, gastroi-ntestinal tract reaction （8 cases）, but no obvious nephric adverse effects were observed during the treatment process. Conclusion CsA is safe and effective on refractory NS children,especially to those with SDNS,FRNS and MCD.

关 键 词：环孢素 肾病综合征 难治性 儿童 

分 类 号：R726.9[医药卫生—儿科]