他克莫司联合激素治疗儿童IgA血管炎肾炎的疗效及安全性  

Efficacy and safety of Tacrolimus in combination with glucocorticosteroid in treatment of IgA vasculitis nephritis in children

作　　者：刘福娟[1] 孙超 韩亚男 杨艳君[1] 陈新 尹美娜[1] 韩佩桐 张东风[1] Liu Fujuan;Sun Chao;Han Yanan;Yang Yanjun;Chen Xin;Yin Meina;Han Peitong;Zhang Dongfeng(Pediatric Nephrology and Rheumatology Department,Children's Hospital of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院肾脏免疫科,石家庄050000

出　　处：《中国小儿急救医学》2025年第4期292-296,共5页Chinese Pediatric Emergency Medicine

基　　金：河北省医学科学研究课题计划资助(20180647)。

摘　　要：目的评价他克莫司(TAC)联合糖皮质激素治疗儿童IgA血管炎肾炎(IgAVN)的有效性和安全性。方法选取2015年1月至2022年1月于河北省儿童医院肾脏免疫科确诊IgAVN,表现为大量蛋白尿、或未达到大量蛋白尿水平但经足量激素等治疗尿蛋白持续>0.5 g/24 h,使用TAC联合激素治疗的患儿为研究对象。收集患儿尿蛋白、血白蛋白、血肌酐、空腹血糖等指标,总结TAC的疗效及不良反应。结果共纳入97例患儿,男55例,女42例,诊断IgA血管炎平均年龄(8.65±2.46)岁,95.9%患儿在确诊后30 d内出现肾脏受累。肾穿刺病理检查:Ⅱa级5例,Ⅱb级2例,Ⅲa级31例,Ⅲb级57例,Ⅳb级2例。TAC治疗3个月后,总体有效率为96.9%(94/97);3例患儿病情未缓解,换用其他免疫抑制剂。94例患儿应用TAC治疗1、3、6、12个月后,尿蛋白水平均低于治疗前,差异有统计学意义(P<0.05),呈逐渐下降趋势;血清白蛋白均高于治疗前,差异有统计学意义(P<0.05),呈逐渐上升趋势。TAC治疗3个月、6个月后,患儿血肌酐和空腹血糖有所升高;随着病情缓解,TAC减量,治疗12个月后,血肌酐和空腹血糖均值较前下降。TAC治疗平均(10.8±2.6)个月,平均随访(3.33±1.56)年,最长随访时间8年。随访期间,无胃肠道不适、肝功能损害、重症感染等严重不良反应发生;停用激素和TAC后,80例患儿获得持续缓解。结论TAC联合激素治疗儿童IgAVN总体有效率较高,可快速达到临床缓解,且不良反应相对较少。Objective To assess the efficacy and safety of Tacrolimus(TAC)in combination with glucocorticosteroid(GC)for treating IgA vasculitis nephritis(IgAVN)in children.Methods A retrospective analysis was conducted on pediatric patients who were diagnosed with IgAVN from January 2015 to January 2022 in Children's Hospital of Hebei Province.The patients presented with nephrotic-range proteinuria or persistent urine protein(>0.5g/24 h)despite adequate glucocorticoid and other treatments in patients who do not reach massive proteinuria levels.They were treated with TAC combined with GC.The following laboratory parameters were obtained for outcome assessment:24-hour urinary protein excretion,serum albumin,serum creatinine levels,and fasting blood glucose measurements.The efficacy and adverse reactions of TAC were summarized.Results A total of 97 children(55 males and 42 females)were included.The average age of diagnosis of IgA vasculitis was(8.65±2.46)years,and 95.9%of the children developed renal involvement within 30 days after diagnosis.Pathological examination of renal puncture:5 cases of gradeⅡa,2 cases of gradeⅡb,31 cases of gradeⅢa,57 cases of gradeⅢb,and 2 cases of gradeⅣb.Remission rate at 3 months was 96.9%(94/97).Three patients failed to achieve clinical remission who were treaed with other immunosuppressants.After 1,3,6 and 12 months of TAC treatment,the urine protein levels of 94 children were lower than those before treatment,and the differences were statistically significant(P<0.05),showing a gradual downward trend.Serum albumin levels were higher than those before treatment,and the differences were statistically significant(P<0.05),showing a gradual upward trend.After 3 months and 6 months of TAC treatment,the serum creatinine and fasting blood glucose of the children increased.With the remission of the disease,TAC dosage decreased,the mean values of serum creatinine and fasting blood glucose decreased after 12 months of treatment.The average treatment time of TAC was(10.8±2.6)months,the average

关 键 词：儿童 IgA血管炎肾炎 他克莫司 糖皮质激素 

分 类 号：R726.9[医药卫生—儿科]