环孢素与环磷酰胺联合肾上腺皮质激素治疗婴幼儿肾病综合征的疗效评价  

Clinical evaluation of cyclosporine A or cyclophosphamide combined glucocorticoid in the treatment of infantile nephrotic syndrome

作　　者：邓颖[1] 于生友[1] 于力[1] 王丽娜[1] 

机构地区：[1]广州市第一人民医院儿科,广州510180

出　　处：《新医学》2013年第8期551-555,共5页Journal of New Medicine

基　　金：广东省科技计划项目(2011B020800002)

摘　　要：目的观察环孢素与环磷酰胺联合肾上腺皮质激素(激素)治疗婴幼儿肾病综合征(NS)的临床疗效。方法收集婴幼儿NS 51例,分为环孢素联合泼尼松治疗组(环孢素组)35例和环磷酰胺联合泼尼松治疗组(环磷酰胺组)16例,在口服泼尼松治疗的基础上,环孢素组口服环孢素3～5 mg/(kg·d),环磷酰胺组静脉滴注环磷酰胺10 mg/(kg·d),两组总治疗时间均为6个月。分别记录治疗前、治疗3、6个月时两组患儿的尿常规、尿蛋白定量、血浆胆固醇、血浆白蛋白、血清肌酐和血尿素氮及肝功能的变化,评价疗效,并记录不良反应。结果治疗3、6个月时,环孢素组总有效率为83%、89%、环磷酰胺组为75%、81%,两组比较差异均无统计学意义(P>0.05)。两组患儿各项生化指标均较治疗前好转(P>0.01),治疗3、6个月时,环磷酰胺组患儿的尿蛋白定量均低于环孢素组,血浆白蛋白高于环孢素组(P均<0.01);而环孢素组在治疗3个月时血清肌酐低于环磷酰胺组,治疗6个月时血尿素氮低于环磷酰胺组(P均<0.01)。两组总体不良反应发生情况比较差异无统计学意义(P>0.05),其中环孢素组患儿面部多毛的发生率高于环磷酰胺组,而环磷酰胺组患儿胃肠道反应的发生率高于环孢素组(P均<0.01)。结论临床上对于婴幼儿NS应用环孢素联合激素或环磷酰胺联合激素治疗均可以取得良好的疗效,前者对改善NS患儿的肾功能疗效较佳,后者对改善婴幼儿NS的蛋白尿及低蛋白血症的疗效较好,临床应根据患儿个体状况选择适当的治疗药物。Objective To observe the clinical effect of cyclosporine A （CsA） or cyclophosphamide （CTX） combined glucocorticoid in the treatment of infantile nephrotic syndrome. Methods Fifty-one cases of infantile nephrotic syndrone were selected and divided into CsA group （n = 35 ） and CTX group （n = 16）. On the basis of oral prednisone, the patients were given oral CsA 3 -5 nag/ （kg · d） in CsA group, and intrave- nous CTX 10 mg/ （kg ~ d） in CTX group. The total treatment course were 6 months. Before treatment, 3 and 6 months after treatment, indicators of changes in urine routine, 24 h urinary protein excretion, liver function, renal function （serum creatinine and blood urea nitrogen） , plasma cholesterol, plasma albumin, and recorded adverse reactions were recorded. Results After 3 -6 months, the total effective rate in CsA group was 83%, 89%, and 75%, 81% in cyclophosphamide group. There was no statistically significant between two groups （ P 〉 O. 05 ）. And the biochemical indicators in two groups were improved than before treatment （ P 〉 0. O1 ）. After 3 -6 months, urinary protein in CTX group was lower than that in CsA group, and serum albumin was higher than that in cyclosporine group （P 〈 0. 01 ） ; while serum creatinine after 3 months and blood urea nitro- gen after 6 months in CsA group less than those in CTX group （P 〈 0.01 ）. Adverse reactions in both groups showed no significant difference （ P 〉 0. 05 ）, in which children were more of facial hirsutism in CsA group, and more gastrointestinal reactions in CTX group （P 〈 0. 01 ）. Conclusions For infants and young children with nephrotic syndrome, CsA or CTX combined hormone therapy could achieve good effect, the former could he better to improve renal function, and the latter could be better to improve proteinuria and hypoproteinemia. It should be based on the individual clinical situation of every patient to select the appropriate treatment.

关 键 词：环孢素 环磷酰胺 泼尼松 肾病综合征 婴幼儿 

分 类 号：R726.9[医药卫生—儿科]