CAJ | 학술논문

目的分析评估他克莫司对治疗儿童激素抵抗型肾病综合征的疗效及其安全性.方法采用回顾性纵向研究分析21例激素抵抗型肾病综合征患儿,他克莫司初始剂量0.10 ～0.15 mg/(kg·d),每12小时1次,定期监测血药浓度、尿常规、血常规及肝肾功能等指标.同时口服小剂量泼尼松0.20 ～0.75 rmg/( kg·d).结果 1～3个月后观察近期疗效,完全缓解者14例,部分缓解者7例,完全缓解率66.7％.16例患儿接受了肾活检,其中6例微小病变型肾病患儿中3例完全缓解,3例部分缓解；4例局灶节段性肾小球硬化患儿中2例完全缓解,2例部分缓解；5例lgM肾病及1例系膜增生性肾小球肾炎患儿均完全缓解.服药期间6例患儿出现一过性不良反应,经对症处理后均缓解.20例患儿获随访,1年内共4例复发,第2年共4例6次出现复发.结论他克莫司对儿童激素抵抗型肾病综合征有较好的疗效,不良反应较少,大多可耐受,但服药1～2年内复发率较高,因此其长期疗效仍有待于进一步随访观察.
목적 분석평고타극막사대치료인동격소저항형신병종합정적료효급기안전성.방법 채용회고성종향연구분석21례격소저항형신병종합정환인,타극막사초시제량0.10 ～0.15 mg/(kg·d),매12소시1차,정기감측혈약농도、뇨상규、혈상규급간신공능등지표.동시구복소제량발니송0.20 ～0.75 rmg/( kg·d).결과 1～3개월후관찰근기료효,완전완해자14례,부분완해자7례,완전완해솔66.7％.16례환인접수료신활검,기중6례미소병변형신병환인중3례완전완해,3례부분완해；4례국조절단성신소구경화환인중2례완전완해,2례부분완해；5례lgM신병급1례계막증생성신소구신염환인균완전완해.복약기간6례환인출현일과성불량반응,경대증처리후균완해.20례환인획수방,1년내공4례복발,제2년공4례6차출현복발.결론 타극막사대인동격소저항형신병종합정유교호적료효,불량반응교소,대다가내수,단복약1～2년내복발솔교고,인차기장기료효잉유대우진일보수방관찰.
Objective To analyze and evaluate the efficacy and safety of tacrolimus and low-dose steroids in the treatment of steroid-resistant nephrotic syndrome in children.Method Twenty-one children with steroid-resistant nephrotic syndrome enrolled from October 2008 to July 2010 into this retrospective longitudinal study received oral tacrolimus treatment,0.1 to 0.15 mg/kg per day and once every 12 hours,and prednisone 0.2 to 0.75 mg/kg per day simultaneously.During the treatment,the plasma concentration of tacrolimus,urine volume,urine,serum creatinine and liver function were regularly monitored.Result After 1 to 3 months treatment,14 cases showed complete remission and 7 cases had partial remission.Sixteen patients received renal biopsy,of whom 6 revealed minimal change nephropathy with complete remission in 3 cases,3 cases had partial remission ;4 cases revealed focal segmental glomerulosclerosis with 2 complete remission and 2 partial remission; other 5 children with IgM nephropathy and 1 mesangial proliferative glomerulonephritis achieved complete remission.Within treatment period,6 patients presented transient adverse reactions,without altering the principle treatment strategy,but only taking the symptomatic treatment.During follow-up,1 case was lost to follow-up and the remaining 20 cases were followed up from 2 months to 21 months.In 4 patients the disease relapsed within 1st-year follow-up,while at 2nd-year follow-up,4 cases had (6 times) recurrence.Conclusion Tacrolimus showed a reliable effect in children with steroid-resistant nephrotic syndrome.Less adverse reactions were seen,and most of them could be tolerated.Nevertheless,the patients had a higher relapse rate after 1 to 2 years treatment.Therefore,the long-term effects of tacrolimus for steroid-resistant nephrotic syndrome remains to be further evaluated.