环孢素A治疗儿童难治性肾病综合征疗效观察  

The effects of cyclosporine A in children with refractory nephrotic syndrome

作　　者：简珊[1] 何艳燕[1] 宋红梅[1] 魏珉[1] 

机构地区：[1]北京协和医院儿科,北京100730

出　　处：《临床儿科杂志》2010年第4期330-333,370,共5页Journal of Clinical Pediatrics

摘　　要：目的观察环孢素A(CsA)治疗儿童难治性肾病综合征(RNS)的临床疗效。方法回顾性分析CsA联合泼尼松治疗儿童RNS的疗效,监测CsA治疗前后相关生化指标,并观察药物不良反应。27例患儿中激素抵抗14例,激素依赖6例,频复发7例;其中25例行肾活检,微小病变型肾病15例,局灶性节段性硬化性肾小球肾炎4例,系膜增生性肾小球肾炎4例,膜增殖性肾小球肾炎2例。CsA剂量2～5mg/(kg·d),疗程6～24个月(平均11.6±6.6个月)。结果完全缓解15例,部分缓解9例,无效3例,总有效率88.9%。激素抵抗组、激素依赖组及频复发组的疗效差异无统计学意义。激素抵抗组完全缓解者起效时间较激素依赖组及频复发组长。不同病理类型的RNS患儿对CsA的治疗反应差异无统计学意义。血胆固醇≤9.0mmol/L组的完全缓解率较血胆固醇>9.0mmol/L组高。CsA的主要不良反应依次为多毛、轻度肝损、血肌酐升高等,均不影响CsA继续使用。结论CsA联合泼尼松治疗难治性肾病综合征安全有效。Objective To evaluate the efficacy of cyclosporine A （CsA） plus prednisone in the treatment of refractory nephrotic syndrome （RNS） in children.Methods In this retrospective analysis of the therapy of CsA （2 ～ 5 mg /（kg·d）） plus prednisone,27 cases,14 cases of steroid-resistant NS,6 cases of steroid-dependent NS and 7 cases of frequent relapse NS were included.In 25 cases of renal biopsies,15 had minimal change nephropathy,4 had focal segmental sclerosis glomerulonephritis,4 had mesangial proliferative glomerulonephritis and 2 had mesangial proliferative glomerulonephritis.Results Cyclosporine A was received for a period of 6 to 24 months （mean 11.6 ± 6.6 mos）.CsA induced complete remission in 16 cases,partial remission in 9 cases and invalid in 2 cases.The total remission rate was 88.9%.The response to CsA was no significant differences in SRNS,SDNS and FRNS.Different renal pathological types did not effect the response.The rate of complete remission was significantly higher in patients with cholesterin level less than 9.0 mmol /L as compared with those with cholesterin level more than 9.0 mmol /L.The main adverse effects of CsA included hirsutism,mild hypertension,mild liver function impairment,creatinine increase,gingival enlargement etc,and all were acceptable.Conclusions CsA combined with prednisone is effective and safe in the treatment of children with RNS.

关 键 词：环孢素A 肾病综合征 儿童 

分 类 号：R726.9[医药卫生—儿科]