他克莫司在婴幼儿激素耐药型肾病综合征的临床应用  

Clinical application of Tacrolimus to infant steroid - resistant nephrotic syndrome

作　　者：廖欣 高岩 杨华彬 林金爱 刘维峰 李颖杰 

机构地区：[1]广州市妇女儿童医疗中心肾内科,510120 [2]广州市卫生监督所传染病防治与血液监督科,510080

出　　处：《中华实用儿科临床杂志》2017年第2期124-129,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析婴幼儿激素耐药型肾病综合征（SRNS）的特点，评估他克莫司（TAC）治疗婴幼儿SRNS的疗效、安全性及复发情况。 方法2012年8月至2015年8月广州市妇女儿童医疗中心2岁以下确诊SRNS的76例患儿，患儿分3组：口服TAC组（TAC组）、大剂量甲泼尼龙冲击组（MP冲击组）及大剂量甲泼尼龙联合环磷酰胺（CTX）冲击组（MP＋CTX冲击组），观察1年，记录入组患儿各时间点的尿蛋白定量、淋巴细胞计数、肾功能、血糖、尿视黄醇结合蛋白（URBP）、血白细胞及尿红细胞等，监测感染及尿蛋白复发情况，对照研究3组患儿的数据资料。 结果入组患儿均行肾脏病理活检，其中微小病变36例，系膜增生性肾小球肾炎32例，局灶节段性肾小球硬化8例，3组患儿病理类型构成比差异无统计学意义。6个月时，TAC组尿蛋白完全缓解率达63.64%，总缓解率95.45%；MP冲击组完全缓解率26.09%，总缓解率60.87%；MP＋CTX冲击组完全缓解率41.94%，总缓解率74.19%。治疗6个月，TAC组尿蛋白定量[（7.8±8.6） mg/（kg·d）]明显低于MP冲击组[（144.2±118.3） mg/（kg·d）]及MP＋CTX冲击组[（91.3±87.4） mg/（kg·d）]，差异有统计学意义（F＝22.69，P〈0.05）；TAC组于治疗2个月尿蛋白显著降低，另2组则延至3个月尿蛋白明显降低。治疗1年后，TAC组各项T淋巴细胞计数均显著低于治疗前，差异均有统计学意义（均P〈0.01）；且分别低于同期的MP冲击组和MP＋CTX冲击组，差异均有统计学意义（均P〈0.05）；B淋巴细胞则无此变化。观察期内，TAC组感染人次明显低于MP冲击组及MP＋CTX冲击组，差异均有统计学意义（秩和值分别为348.5和369.5，U＝－3.69、－4.18，均P〈0.01）。TAC组血糖及校正CCr治疗前后均无明显变化，但URBP于TAC组呈可逆性升高，且明显高于MP冲击组及MP＋CTX冲击组[（13.77±19.19） mg/L比（2.50±1.77） mg/Objective To analyze the peculiarity of infants steroid-resistant nephrotic syndrome （SRNS） and to assess the efficacy,side - effect and relapse of various of Tacrolimus prescribed in infants SRNS. Methods A total of 76 case of infant SRNS from August 2012 to August 2015 in Guangzhou Weman and Children＇s Medical Center grouped into oral Taerolimus （ TAC group ）, Methyprenisolone pulse therapy （ MP group） and Methyprenisolong com- bined Cyclophosphamide（CTX） pulse therapy（ MP ＋ CTX group） , were observed for 1 year, and the urine protein ex- cretion, renal function （CCr）, blood glucose （BG）, urine retinal- binding- protein（URBP） ,lymphocyte count etc. were recorded and the situation of infection and relapse regularly were monitored regularly. The data were retrospectively ana- lyzed by the statistical method. Results All SRNS children underwent kidney biopsy, and 36 cases of minimal change disease,32 cases of mesangial proliferative glomerulonephritis and 8 cases of focal segmental glome-ruloselerosis were contained in the patients. The pathological constituent ratios were not obviously different among these 3 groups. By 6 - month follow - up, the complete remission ratio of TAC group was 63.64%, the total remission ratio was 95.45%, which were remarkably higher than those of MP group （ 26. 09%, 60. 87% ） and MP ＋ CTX group （ 41. 94%, 74. 19% ） ;the urine protein excretion of TAC group [ （7.8 ＋8.6） mg/（kg ~ d） ] was distinctly lower than that of pre- treatment and lower than that of MP group[ （ 144.2 ＋ 118.3） mg/（kg ~ d） ] ,and lower than that of MP ＋ CTX group [ （91.3 -＋ 87.4） mg/（ kg· d） 1, and the difference was significant （ F = 22.69, P 〈 0.05 ）. The remission time of TAC group was about 2 months,that of other two groups was about 3 months. By 1 - year follow - up,the lymphocyte counts including total T - cell （ CD3 ＋ ） , the helper T - cell （ CD4＋） and the inhibited T - cell （ CD8＋ ） of TAC group decreased

关 键 词：他克莫司 婴幼儿 激素耐药型肾病综合征 

分 类 号：R726.9[医药卫生—儿科]