中南大学学报（医学版）
中南大學學報（醫學版）
중남대학학보（의학판）
JOURNAL OF CENTRAL SOUTH UNIVERSITY (MEDICAL SCIENCES)
2008年
1期
1-7
,共7页
原发性肾病综合症%药物治疗%病程%治疗方案%治疗目标%儿童
原髮性腎病綜閤癥%藥物治療%病程%治療方案%治療目標%兒童
원발성신병종합증%약물치료%병정%치료방안%치료목표%인동
idiopathic nephrotic syndrome%drug treatment%clinical course%treatmentstrategy%goals%children
皮质激素、烷基化物如环磷酰胺、苯丁酸氮芥用于原发性肾病综合症近50年,改变了肾病综合症儿童的预后.然而,长期使用激素,尤其较高剂量却引起严重副作用.较新药物如环孢A、左旋咪唑、他克莫司、霉酚酸酯可免去不少激素副作用.在选择药物时,应衡量及平衡效益与副作用,并考虑药物价格.虽然大部份肾病综合症儿童都会复发,然而预后却良好,不少肾病综合症儿童成长后不再复发,或只间有复发,故治疗方案应以最少药物以维持缓解,以过渡儿童期,避免不必要的副作用.至于激素抵抗(SRNS)者,尤其局部节段性肾小球硬化(FSGS),预后可致终末期肾衰;治疗方面,用药可较为进取,多需较强免疫抑制剂如环孢A、他克莫司、霉酚酸酯等加以控制.治疗肾病综合症儿童的长期目标,还需考虑生长、教育与心理影响,尤其在过渡青春期时,能让他们正常地成长.
皮質激素、烷基化物如環燐酰胺、苯丁痠氮芥用于原髮性腎病綜閤癥近50年,改變瞭腎病綜閤癥兒童的預後.然而,長期使用激素,尤其較高劑量卻引起嚴重副作用.較新藥物如環孢A、左鏇咪唑、他剋莫司、黴酚痠酯可免去不少激素副作用.在選擇藥物時,應衡量及平衡效益與副作用,併攷慮藥物價格.雖然大部份腎病綜閤癥兒童都會複髮,然而預後卻良好,不少腎病綜閤癥兒童成長後不再複髮,或隻間有複髮,故治療方案應以最少藥物以維持緩解,以過渡兒童期,避免不必要的副作用.至于激素牴抗(SRNS)者,尤其跼部節段性腎小毬硬化(FSGS),預後可緻終末期腎衰;治療方麵,用藥可較為進取,多需較彊免疫抑製劑如環孢A、他剋莫司、黴酚痠酯等加以控製.治療腎病綜閤癥兒童的長期目標,還需攷慮生長、教育與心理影響,尤其在過渡青春期時,能讓他們正常地成長.
피질격소、완기화물여배린선알、분정산담개용우원발성신병종합증근50년,개변료신병종합증인동적예후.연이,장기사용격소,우기교고제량각인기엄중부작용.교신약물여배포A、좌선미서、타극막사、매분산지가면거불소격소부작용.재선택약물시,응형량급평형효익여부작용,병고필약물개격.수연대부빈신병종합증인동도회복발,연이예후각량호,불소신병종합증인동성장후불재복발,혹지간유복발,고치료방안응이최소약물이유지완해,이과도인동기,피면불필요적부작용.지우격소저항(SRNS)자,우기국부절단성신소구경화(FSGS),예후가치종말기신쇠;치료방면,용약가교위진취,다수교강면역억제제여배포A、타극막사、매분산지등가이공제.치료신병종합증인동적장기목표,환수고필생장、교육여심리영향,우기재과도청춘기시,능양타문정상지성장.
Corticosteroid, alkylating agents, like cyclophosphamide and chlorambucil, have been used to treat idiopathic nephrotic syndrome for more than fifty years, changing the outcome of these children. However, with long-term use of steroid, especially high dosages, they have unbeara-ble side effects. Newer agents like cyclosporine A, levamisole, taerolimus, mycophenolate mofefil, have been used to spare those unwanted side effects. In the choice of drugs, the benefits obtained will have to be evaluated against possible side effects, with drug cost also taken into consideration. Though most steroid sensitive nephrotie children may run a relapsing course, have a good prognosis with many becoming non-relapsers or infrequent relapsers in adulthood, the treatment approach should aim at using the minimal amount of drug required to keep patient in remission to tie them over child-hood. As for steroid resistant nephrotie syndrome children, especially for focal segmental glomerulo-sclerosis (FSGS) , because of possible grave prognosis of going into end-stage renal failure, more ag-gressive approach should be adopted, including the use of strong immunosuppressants, such as, cy-closporine, tacrolimus, or mycophenolate mofetil if necessary. The long-term goals of treatment, other than those of physical and medical conditions, should also consider the growth, education, and psychological impact of the disease and side effects of drugs on the child, especially during an adoles-cent period,so an to allow them having normal development into adulthood.
