CAJ | 학술논문

目的：观察比较环磷酰胺( CTX )、环孢素 A ( CsA )治疗儿童激素耐药型原发性肾病综合征( SRNS)诱导缓解及维持缓解的疗效。方法：回顾性研究应用CTX或CsA治疗的51例SRNS患者的临床资料。结果：治疗3个月时,CsA组完全缓解率(18/25 vs 9/26)及有效率(21/25 vs 14/26)均高于CTX组。CTX组与CsA组最终的完全缓解率(16/26 vs 19/25)及有效率(17/26 vs 21/25)差异无显著性。 CsA组尿蛋白阴转时间(中位数表示)短于CTX组(21天 vs 75天)。病理为局灶节段性肾小球硬化(FSGS)治疗8周时,CsA组尿蛋白阴转比例(8/10 vs 1/8)、有效率(8/10 vs 2/8)均高于CTX组。 CTX组维持缓解时间(以中位数表示)长于CsA组(16.0个月 vs 10.0个月)。随访1年时CTX组维持缓解者所占比例高于CsA组(12/16 vs 7/17)。结论： CTX与CsA治疗SRNS的总有效率相当,但CsA起效更快,尤其对FSGS效果显著；而CTX维持缓解的作用优于前者。
목적：관찰비교배린선알( CTX )、배포소 A ( CsA )치료인동격소내약형원발성신병종합정( SRNS)유도완해급유지완해적료효。방법：회고성연구응용CTX혹CsA치료적51례SRNS환자적림상자료。결과：치료3개월시,CsA조완전완해솔(18/25 vs 9/26)급유효솔(21/25 vs 14/26)균고우CTX조。CTX조여CsA조최종적완전완해솔(16/26 vs 19/25)급유효솔(17/26 vs 21/25)차이무현저성。 CsA조뇨단백음전시간(중위수표시)단우CTX조(21천 vs 75천)。병리위국조절단성신소구경화(FSGS)치료8주시,CsA조뇨단백음전비례(8/10 vs 1/8)、유효솔(8/10 vs 2/8)균고우CTX조。 CTX조유지완해시간(이중위수표시)장우CsA조(16.0개월 vs 10.0개월)。수방1년시CTX조유지완해자소점비례고우CsA조(12/16 vs 7/17)。결론： CTX여CsA치료SRNS적총유효솔상당,단CsA기효경쾌,우기대FSGS효과현저；이CTX유지완해적작용우우전자。
Objective To compare the therapeutic efficacy and the effect of reducing relapse rate of cyclophosphamide (CTX) and cyclosporine-A(CsA) in the treatment of steroid-resistant idiopathic nephrotic syndrome(SRNS) in children. Method 51 cases who were admitted to the Children's Hospital Affiliated to Capital Institute of Pediatrics between Janu-ary 1986 and September 2012 diagnosed as INS with SRNS were analysed in a retrospective study,including 26 cases in CTX group and 25 cases in CsA group. Result On 3 months follow-up,children receiving CsA had a better response than those treated with CTX,the total efficacy(21/25 vs 14/26) and proportion achieve complete remission(18/25 vs 9/26) showed significant difference. After prolonged therapy the proportion achieve complete remission and total efficacy did not show significant difference compared those two groups. The duration time(median) of urinary protein negative conversion time in CsA group shorter than that in CTX group(21d vs 75d). For 18 cases of FSGS receiving CTX or CsA first as a second-line immunosuppressive drug up to 8 weeks, the proportion of cases achieve remission in CsA group was higher than that in CTX group(8/10 vs 1/8),the total efficacy in CsA group was higher than that in CTX group(8/10 vs 2/8). The duration time(median) of maintain remission in CTX group is longer than that in CsA group (16. 0 month vs 10. 0 month). The maintain remission rate with CTX therapy is higher than that with CsA therapy(12/16 vs 7/17)after 1 years follow-up. Conclusion This retrospective study showed that CsA is more effective than CTX for patients with SRNS espe-cially for FSGS in short term,but CTX has advantage on maintain remission.