多靶点治疗儿童狼疮肾炎的疗效观察  

Clinical observation of multi-target therapy in children with lupus nephritis

作　　者：王笑秋[1] 殷蕾[1] 茅幼英[1] 黄华[1] 周征宇[1] 周纬[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心肾脏风湿科,200127

出　　处：《中华风湿病学杂志》2014年第9期607-611,共5页Chinese Journal of Rheumatology

基　　金：国家自然科学青年基金（81100536）

摘　　要：目的 探讨联合应用钙调磷酸酶抑制剂（环孢素A/他克莫司）治疗诱导期或维持期对霉酚酸酯耐药的儿童LN的临床疗效.方法 收集2005年1月至2011年12月在我院肾脏风湿科门诊或病房采用糖皮质激素＋霉酚酸酯＋钙调磷酸酶抑制剂多靶点治疗诱导期或维持期对霉酚酸酯耐药的10例LN患儿临床资料.采用重复测量方差分析进行统计学分析.结果 多靶点治疗前后的SLEDAI分别为10.9±3.8和7.9±2.6、尿蛋白定量（24 h）分别为（4.0±2.0）g和（2.2±1.8） g、ESR分别为（78±10） mm/1 h和（54±8）mm/1 h,均有明显下降（P＜0.01）;血清白蛋白分别为（29±8）g/L和（34±8）g/L及补体C3水平分别为（0.41±0.20） g/L和（0.70±0.30） g/L,均有明显升高（P＜0.05）.6个月时完全缓解率为70％,总体有效率达到90％,24个月时完全缓解率为90％,1例因自行停药,病情恶化最终放弃治疗,其余9例均随访24个月.患儿不良反应少,1例发生肺部感染,1例血糖升高,1例转氨酶升高,经积极对症治疗后可治愈.结论 联合应用钙调磷酸酶抑制剂（环孢素A/他克莫司）对霉酚酸酯诱导期及维持期治疗耐药的儿童LN快速且有效,诱导和维持期两药剂量均较低,在保证疗效的同时,减少了不良反应的发生。Objective To explore the efficacy of mycophenolate mofetil-based induction or maintenance therapy for children with lupus nephritis combined with Calcineurin inhibitors （cyclosporine A/tacrolimus） for resistant cases.Methods the clinical data were analyzed for 10 patients treated with multi-target therapy （Glucocorticoid ＋ Mycophenolate mofetile＋ Cyclosporine A/Tacrolimus） in Department of Nephrology and Rheumatology from January 2005 to December 2011.Calcineurin inhibitor （Cyclosporine A/Tacrolimus） was added when Mycophenolate mofetil-based induction or maintenance protocol was not satisfactory.The data was analyzed by repeated measures data of ANOVA.Results The SLEDAI score （10.9±3.8 vs 7.9±2.6）,24 hours urinary protein quantification [（4.0±2.0） vs （2.2±1.8） g] and ESR [（78±10） vs （54±8） mm/l h] were decreased significantly （P＜0.01）,while serum albumin [（29±8） vs （34±8） g/L] and complement C3 level [（0.41±0.20） vs （0.70±0.30） g/L] were increased significantly （P＜0.05）.The complete remission rate （CR） was 70％ and the response rate was 90％ in the first 6 month,and the CR was 90％ in the last month.Except 1 case withdrawal,the follow-up period for 9 cases was 24 months.Adverse reactions were rare,1 case had lung in-fection,1 case had hyperglycemia and 1 case had transaminase elevation,which disappeared after mana-gement.Conclusion Mycophenolate mofetil combined with Calcineurin inhibitors （cyclosporine A/tacrolimus） is effective for treating lupus nephritis,the dose of induction or maintenance period is low,and adverse reactions are rare.

关 键 词：儿童 狼疮肾炎 霉酚酸酯 钙调磷酸酶抑制剂 治疗 

分 类 号：R725.9[医药卫生—儿科]