中国实用儿科杂志2017，Vol.32Issue(5)：361-365,5.DOI:10.19538/j.ek2017050611
多靶点免疫抑制剂治疗儿童激素耐药型肾病综合征前瞻性研究
A prospective study of multi-target immunosuppressive therapy for children with steroid-resistant nephritic syndrome
摘要
Abstract
Objective To observe the efficacy and safety of multi-target immunosuppressive therapy in treatment of children with steroid-resistant nephritic syndrome(SRNS).Methods A total of 48 children with SRNS were enrolled in this multicenter prospective study.Based on the same comprehensive treatment,the children were randomly divided into two groups:(1) observation group:they were orally given CSA [3 ～ 4 mg/(kg,d)] and MMF [20 mg/(kg· d)] multitarget immunosuppressive therapy;(2)control group:they were orally given CSA [4 ～ 6 mg/(kg,d)].The side effects were closely observed.The plasma concentrations of CSA,urine protein to creatinine ratios,liver and kidney function,blood routine and urine β2-microglobulin were respectively compared between the two groups after 2 weeks,1 month,3 months and 6 months of treatment.Results The average plasma concentrations of CSA in the observation group was (88.86+ 16.94) μg/L,and in the control group it was (152.96±+ 19.20) μg/L(P ＜ 0.001).The urine protein to creatinine ratios in the observation group after 1 month and 3 months of treatment were lower than the control group in the same time period (P ＜ 0.05).The serum albumin in the observation group after 1 month and 3 months of treatment was higher than the control group in the same time period (P ＜ 0.05).The urine β2-microglobulin in these two groups had no differences during the treatment (P ＞ 0.05).The overall remission rate.of the observation group was 88％,and in the control group it was 87％.The remission rate of the observation group after 2 weeks and 1 month of treatment was better than the control group (P ＜ 0.05).The main side effect during therapy was infection,gastrointestinal reaction,crinosity,hypertension and leukocyte decrease.The side effect of the observation group was less than the control group (P ＜ 0.05).Conclusion The multi-target therapy in children with SRNS by CSA and MMF results in early remission and can keep long-term remission with mild side effect.关键词
激素耐药型肾病综合征/多靶点/免疫抑制剂/儿童Key words
steroid-resistant nephritic syndrome/multi-targe therapy/immunosuppressant/child分类
医药卫生引用本文复制引用
徐达良,汪海涛,付明丽,董扬,杨巧芝,邵晓珊,李志辉,吴琳,朱颖,江家云..多靶点免疫抑制剂治疗儿童激素耐药型肾病综合征前瞻性研究[J].中国实用儿科杂志,2017,32(5):361-365,5.基金项目
安徽省卫生和计划生育委员会妇儿科题(13FR018) （13FR018）
