促皮质素治疗儿童频复发型肾病综合征复发的临床观察  

Clinical observation of the treatment of adrenocorticotropic hormone in children with frequently relapsing nephrotic syndrome

作　　者：韩玫瑰[1] 李烁 韩子明[1] 朱小娟 张芳敏[1] 黄倩[1] Han Meigui;Li Shuo;Han Ziming;Zhu Xiaojuan;Zhang Fangmin;Huang Qian(Department of Pediatrics,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院儿内科,河南卫辉453100

出　　处：《中华实用儿科临床杂志》2020年第8期637-640,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省卫计委科技攻关项目(201702126)。

摘　　要：目的观察促皮质素(ACTH)治疗儿童频复发型肾病综合征(FRNS)的疗效和不良反应,探讨ACTH在儿童FRNS中的可行性治疗方案。方法选择2017年11月至2018年6月在新乡医学院第一附属医院儿科接受ACTH治疗的32例FRNS患儿,所有患儿行连续ACTH 3~8个疗程治疗方案(每天激素用量≤0.5 mg/kg时予补充0.4 U/kg ACTH,连续应用3 d后激素减量至1.25~5.00 mg,连续应用3 d为1个疗程,至激素减停后继续应用ACTH治疗2个疗程),记录ACTH治疗后随访期间内复发次数、泼尼松维持剂量、免疫抑制剂使用状况、晨8时血清皮质醇等相关实验指标及不良反应,随访观察8~15个月。结果32例患儿中,发病年龄(53.47±25.81)个月,病程(35.25±23.87)个月,激素顺利减停无复发22例(68.75%),激素减停后复发7例(21.87%),激素未减停复发3例(9.37%)。与ACTH治疗前比较,泼尼松用量明显减少[(0.08±0.14)mg/(kg·d)比(0.23±0.23)mg/(kg·d)],差异有统计学意义(t=3.661,P<0.05);免疫抑制剂应用例数明显下降[42.38%(12/32例)比58.62%(17/32例),χ^2=14.500,P<0.05];晨8时血清皮质醇水平升高[(11.78±4.64)μg/dL比(4.42±3.13)μg/dL,差异有统计学意义(t=7.340,P<0.05)]。随访期间效果稳定,其中2例出现1次全身荨麻疹,1例输注后出现头痛。结论ACTH治疗儿童FRNS安全有效,且不良反应发生少,有一定的临床意义。Objective To observe the efficacy and adverse reactions of adrenocorticotropic hormone(ACTH)in the treatment of recurrent frequently relapsing nephrotic syndrome(FRNS),and explore the feasibility of treatment of ACTH in children.Methods From November 2017 to June 2018,in the First Affiliated Hospital of Xinxiang Medical University of a total of 32 cases of FRNS ACTH therapy were all the role of ACTH consecutive 3-8 courses of treatment(when the dosage of prednisone was less than or equal to 0.5 mg/kg,0.4 U/kg ACTH should be used every day.After 3 days of continuous application,the dosage of Prednisone should be reduced to 1.25-5.00 mg.ACTH was used for 3 days as a course of treatment,and continued to use ACTH for 2 courses until corticosteroid stopped).The number of recurrence,Prednisone maintenance dose,immunosuppressive use,serum cortisol and other relevant experimental indicators and adverse reactions were recorded during the follow-up period after ACTH treatment,and were followed up for 8-15 months.Results Among the 32 children,the onset age(53.47±25.81)months,the course of disease(35.25±23.87)months,22 patients(68.75%)had no recurrence after corticosteroid withdrawal,7 patients(21.87%)had recurrence after corticosteroid withdrawal,and 3 patients(9.37%)had recurrence during corticosteroid withdra-wal.Compared with before ACTH treatment,Prednisone was significantly decreased[(0.08±0.14)mg/(kg·d)vs.(0.23±0.23)mg/(kg·d)],and the difference was statistically significant(t=3.661,P<0.05),the number of immunosuppressant cases decreased significantly[42.38%(12/32 cases)vs.58.62%(17/32 cases),χ^2=14.500,P<0.05].Serum cortisol was measured at 8 Am increased significantly[(11.78±4.64)μg/dL vs.(4.42±3.13)μg/dL,t=7.340,P<0.05].The results were stable during follow-up,with 2 patients presenting with systemic urticaria once and 1 patient presenting with headache after infusion.Conclusions ACTH therapy is safe and effective in hormone therapy for child with FRNS,and less adverse reactions.

关 键 词：频复发型肾病综合征 促肾上腺皮质激素 血清皮质醇 儿童 

分 类 号：R726[医药卫生—儿科]