霉酚酸酯与环磷酰胺冲击疗法治疗儿童紫癜性肾炎的疗效比较  

Treatment of Children Henoch-Schnlein Purpura Nephritis with Mycophemelate Mofeil or Cyclophosphamide

作　　者：杜悦[1] 吴玉斌[1] 李心瑶[2] 

机构地区：[1]中国医科大学附属盛京医院儿肾科,沈阳110004 [2]中国医科大学第95期临床医学7年制,沈阳110001

出　　处：《中国医科大学学报》2010年第5期352-355,共4页Journal of China Medical University

基　　金：辽宁省教育厅高校科研基金计划项目(2008767);辽宁省科学技术计划项目(2008225010-8)

摘　　要：目的观察霉酚酸酯(MMF)和环磷酰胺(CTX)对肾病综合征型紫癜性肾炎(HSPN)患儿的疗效及其不良反应。方法有过敏性紫癜病史,表现为肾病综合征水平的蛋白尿和肉眼血尿或大量镜下血尿的患儿65例,给予甲基强地松龙(MP)冲击2个疗程无效后随机分为2组:MMF组40例,CTX组25例,分别给与MMF口服(20～25mg·kg-1·d-1,日2次空腹口服,治疗6个月后逐渐减量,治疗9～12个月后基本停药)和CTX冲击治疗(10mg·kg-1·d-1,连续2d静脉滴注,每2周重复1次,连用3个月,之后每3个月重复1次至1年)。于治疗前及治疗后1,3,6,9,12个月测定24h尿蛋白定量,血尿素氮,肌酐,肝功,甘油三酯,胆固醇,血常规,内生肌酐清除率等,同时记录患儿的异常临床表现。结果治疗3个月时,2组24h尿蛋白定量较治疗前均明显下降,但MMF组的下降程度明显大于CTX组(P<0.05);治疗12个月时,MMF组尿蛋白平均含量明显低于CTX组(P<0.05)。MMF组血清甘油三酯、胆固醇含量在治疗后6,9,12个月时较治疗前明显下降(P<0.05)。治疗前后血尿素氮、肌酐、内生肌酐清除率2组比较无明显改变。MMF组随诊12个月时完全缓解率为94%,总有效率100%,明显高于CTX组(P<0.05)。MMF组无明显不良反应,CTX组白细胞减少10例、脱发4例、出现消化道症状12例。结论 MMF治疗儿童紫癜性肾炎肾病综合征型的疗效好于CTX,且近期毒副作用小,耐受好。Objective To explore the therapeutic effects and side effects of mycophemelate mofeil （MMF）or cyclophosphamide for the children Henoch-Schnlein purpura nephritis（HSPN）with nephrotic syndrome. Methods Sixty-five children who suffered from HSPN with nephrotic-range proteinuria and hematuria or with only nephrotic-range proteinuria were given intravenous administration of pulse methylprednisolone firstly twice,who did not respond to the treatment were enrolled. These patients were randomly divided into two groups. Forty patients were treated with oral intake of MMF （MMF group）15～25 mg·kg-1·d-1 for 6months,then gradually withdrawn at the 12th month. Other twenty-five patients were treated with intravenous pulse administration of cyclophosphamide （CTX group,10～15 mg·kg-1·d-1,2 days）once every two weeks for 12 weeks,then once every three months for 9 months. Clinical assessment,24-hour urinary protein,creatinine clearance （CCr）,liver function,total cholesterol,triglyceride and side effect were performed at the 1st,3rd,6th,9th and 12th month. Results The amount of 24-hour urinary protein was much lower in the children with MMF after 3 and 12 months treatment（1.8±1.6,0.3±0.5）than that of CTX（2.5±1.7,1.3±1.4）group（P 0.05）. The levels of serum total cholesterol and triglyceride were significantly decreased in the children with MMF after 6,9,12 months treatment compared with pretreatment （P 0.05）,but those were not changed in the children with CTX treatment compared with pretreatment （P 0.05）. CCr was not changed in these two groups compared with pretreatment. After 12 months treatment,the complete remission rate and the effective rate of MMF group were 94% and 100%,much higher than those of CTX group（P 0.05）. The side effects of MMF were much weak. The side effects of CTX included the decreased white blood cells and vomitting. Conclusion The therapeutic effects of MMF is better than CTX in the children of HSPN with nephrotic syndrome and the side effects of MMF is

关 键 词：过敏性紫癜肾炎 霉酚酸酯 环磷酰胺 不良反应 

分 类 号：R692.3[医药卫生—泌尿科学]