他克莫司与环磷酰胺治疗儿童激素依赖/频复发型肾病综合征的效果比较  

Comparison of efficacy of tacrolimus and cyclophosphamide in the treatment of frequently relapsing and steroiddependent nephrotic syndrome in children

作　　者：蒋罗 于力[1] 于生友[1] 郝志宏[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院儿科,510180

出　　处：《广东医学》2015年第13期1971-1974,共4页Guangdong Medical Journal

基　　金：国家科技支撑计划项目(编号:2012BAI03B02);国家自然科学基金资助项目(编号:81273205)

摘　　要：目的比较口服他克莫司(FK506)与环磷酰胺(CTX)静脉冲击治疗儿童激素依赖型肾病综合征(SDNS)/频复发型肾病综合征(FRNS)的临床效果及安全性。方法将38例SDNS/FRNS患儿分为FK506组21例和CTX组17例。FK506组在口服泼尼松基础上,加FK506口服,CTX组在口服泼尼松基础上,加CTX静脉冲击治疗。随访观察至少1年,比较两组治疗前后的复发频率、激素剂量的变化以及治疗6、12个月时各项生化指标的变化,并记录其不良反应。结果 (1)FK506组复发频率由(5.7±2.8)次/年降至(1.2±0.7)次/年,激素剂量由(37.9±15.3)mg/d降至(14.6±8.3)mg/d(P<0.01);CTX组复发频率由(4.8±2.5)次/年降至(1.0±0.6)次/年(P<0.01),激素剂量由(35.3±14.2)mg/d降至(12.4±7.8)mg/d(P<0.01);(2)两组患儿在治疗6、12个月时的各项生化值均较治疗前好转,差异有统计学意义(P<0.05),而同时间点组间比较差异无统计学意义(P>0.05);(3)FK506组2例患儿出现轻度胃肠道反应,CTX组4例患儿有不同程度胃肠道反应,1例外周血白细胞轻度下降,1例转氨酶轻度升高,给予对症处理后均好转,两组均未见严重感染。结论在治疗SDNS/FRNS中FK506与CTX在降低复发频率、协助激素减量等方面疗效相似。鉴于FK506治疗效果好、不良反应少及对性腺无损害的优势,尤其是青春期阶段的患儿,考虑选择FK506替代CTX治疗。Objective To compare the clinical efficacy and safety of tacrolimus（ FK506） and cyclophosphamide（ CTX） in the treatment of steroid- dependent and frequently relapsing nephrotic syndrome（ SDNS /FRNS） in children.Methods The analysis of 38 cases of SDNS / FRNS,whom were assigned into FK506 group（ n = 21） and CTX group（ n = 17）,was conducted. On the basis of oral prednisolone,the patients were given with oral tacrolimus 0. 1- 0. 15 mg /（ kg·d） in FK506 group,and intravenous cyclophosphamide 8- 10 mg /（ kg·d） in CTX group. The total course were at least 1 year. The frequency of recurrence,the steroid dose changes and the biochemical indicators 6 and 12 mouths after treatment were compared,and the adverse reactions were recorded. Results In FK506 group,the relapse frequency from was significantly reduced from（ 5. 7 ± 2. 8） times / year to（ 1. 2 ± 0. 7） times / year,as the steroid dose from（ 37. 9 ±15. 3） mg / d to（ 14. 6 ± 8. 3） mg / d（ P〈0. 01）. In CTX group,the relapse frequency was significantly reduced from4. 8 ± 2. 5 times / year to（ 1. 0 ± 0. 6） times / year（ P〈0. 01）,as the steroid dose from（ 35. 3 ± 14. 2） mg / d to（ 12. 4 ±7. 8） mg / d（ P〈0. 01）. After treatment,the biochemical indicators were significantly improved than baseline（ P〈0. 05）,while there was no significant difference between the two groups（ P〈0. 05）. Gastrointestinal reactions were reported in 2 patients in FK506 group,while gastrointestinal reactions,peripheral blood hypoleukcytosis and transaminase elevation were reported in 4,1 and 1 patients,respectively,in CTX group,whom were improved after symptomatic treatment. No serious infection was reported. Conclusion Both tacrolimus and cyclophosphamide can achieve similar results in the treatment of SDNS / FRNS,including reduction in relapse frequency and steroid use. In view of the good therapeutic effect,fewer side effects and no damage to the gonads in FK506,especially in children with puberty stage,F

关 键 词：他克莫司 环磷酰胺 肾病综合征 激素 儿童 

分 类 号：R692.5[医药卫生—泌尿科学]