甲基强的松龙冲击联合吗替麦考酚酯治疗肾病综合征型儿童紫癜性肾炎疗效观察  

Clinical observation of methylprednisolone pulse therapy combined with mycophenolate mofetil on Henoch-Schonlein purpura nephritis( nephrotic syndrome type) in children

作　　者：刘亚琼[1] 陈佳[1] 余静[1] 谢坚[1] 赵凤华[1] Liu Yaqiong;Chen Jia;Yu Jing;Xie Jian;Zhao Fenghua(Department of Paediatrics,Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]四川省绵阳市中心医院儿科,621000

出　　处：《临床医学》2018年第11期90-92,95,共4页Clinical Medicine

摘　　要：目的探讨甲基强的松龙冲击(甲强龙)及口服激素联合吗替麦考酚酯(MMF)治疗儿童紫癜性肾炎(肾病综合征型)的疗效。方法选取2011年1月至2017年12月儿童紫癜性肾炎(肾病综合征型)患儿34例,分为甲基强的松龙(甲强龙)冲击组(激素冲击组20例)和泼尼松口服组(激素口服组14例),两组同时使用MMF分散片15～20 mg/(kg·d),最大剂量1 g/d,2次/d,治疗后6个月逐渐减量,治疗9～12个月停药。两组同时口服双嘧达莫抗凝,卡托普利改善肾循环及降低血压,黄芪保肾,并口服钙预防骨质疏松等对症治疗。激素冲击组给予甲强龙15～30 mg/(kg·d),静脉滴注,1次/d,连续3 d (1 d最大剂量≤1. 0 g),后给予口服泼尼松1. 5～2. 0 mg/(kg·d),4～6周后减量改隔日口服,每2～4周减2. 5～5. 0 mg,总疗程12个月。如果治疗后4周蛋白尿无缓解,则再次给予甲强龙冲击治疗;激素口服组则不用甲强龙冲击治疗。观察两组患儿治疗4、8、12、16周的尿常规结果,以尿蛋白及尿红细胞定性作为蛋白尿及血尿的标准,并对患儿进行预后评价。结果激素冲击组治疗4周尿蛋白减少80. 0%,明显高于口服激素组的42. 9%(P <0. 05);且激素冲击组8、12周尿蛋白减少显效率为40. 0%、90. 0%,明显高于激素口服组的28. 6%、71. 4%(P <0. 05)。在血尿方面,激素冲击组在治疗4、8周总有效率分别为90. 0%、90. 0%,口服激素组为57. 1%、71. 4%(P <0. 05)。在预后方面,激素冲击组治愈12例(60%)、口服激素组治愈8例(57. 1%),两组比较差异未见统计学意义(P> 0. 05)。结论甲基强的松龙冲击联合吗替麦考酚酯分散片治疗儿童紫癜性肾炎(肾病综合征型),可以快速缓解蛋白尿和血尿,预后良好。Objective To investigate the curative effect and prognosis of Henoch-Schonlein purpura nephritis in children by using methylprednisolone pulse therapy or oral prednisone combined with mycophenolate mofetil. Methods Thirty-four cases with henoch-schonlein purpura nephritis（ nephrotic syndrome type） were divided into two groups from January 2011 to December 2017. One group was given methylprednisolone pulse thrapy（ 20 cases） and the other group was given oral prednisone（ 14 cases）.Both groups were given mycophenolate mofetil 15 ～ 20 mg/（ kg·d）,two times a day,the maximum dose was 1 g/d,the dose was reduced after 6 months and the period of treatment was 9 ～ 12 months. Both groups were given dipyridamole,captopril and calcium supplements. The methylprednisolone pulse therapy group was given methylprednisolone 15 ～ 30 mg/（ kg·d）,intravenous drip,once a day,three days in a row（ the maximum dose was 1 g/d）,after the pluse thrapy,the cases were given prednisone1. 5 ～ 2. 0 mg/（ kg·d）,and then gradually reduced,the total course was 12 months. If proteinuria was not relieved 4 weeks after treatment,methylprednisolone pulse therapy was given again. Routine urine results were observed in two groups after treatment of 4 weeks,8 weeks,12 weeks and of 16 weeks.Urine protein positive and urinary RBC qualitative was standard of proteinuria and hematuria. The prognosis were evaluated at that time. Results The total effective rate of proteinuria was 80. 0% in methylprednisolone pulse therapy group after 4 weeks treatment, which significant higher than that in the oral prednisone group （80. 0% ＆ 42.9% ,P 〈 0.05 ） , and the total effective rates of proteinuria after 8 weeks,12 weeks treatments were also significant higher than those in the oral prednisone group （P 〈 0. 05 ）. The hematuria remission rates in methylprednisolone pulse therapy group after 4 weeks and 8 weeks treament were 90. 0% and 90.0% respectively, while that in oral prednisone group the rates were 57.1% and 71.4%,

关 键 词：过敏性紫癜 肾病综合征 甲基强的松龙 吗替麦考酚酯 

分 类 号：R726.9[医药卫生—儿科]