环孢素A联合激素治疗难治性肾病综合征31例临床疗效观察

目的 探讨环孢素A（cyclosporine-A,CsA）联合激素治疗难治性肾病综合征的临床疗效及安全性.方法 对31例难治性肾病综合征患者使用糖皮质激素联合CsA治疗：CsA起始剂量平均（1.57±0.25）mg·kg^-1 ·d^-1,泼尼松起始剂量平均（0.69±0.20）mg· kg^-1·d^-1,分别测定CsA治疗前及治疗后1、3、6个月患者的24 h尿蛋白定量、肝功能丙氨酸氨基转移酶（glutamate-pyruvate transaminase,AST）、天冬胺酸氨基转移酶（glutamic oxalacetic transaminase,ALT）、血浆白蛋白（serum albumin,Alb）]、肾功能血肌酐（serum creatinine,SCr）、血尿酸（uric acid,UA）]、血常规白细胞（white blood corpuscle,WBC）、血红蛋白（hemoglobin,Hb）、血小板（blood platelet,PLT）]及环孢素血药浓度等指标的变化,并记录不良反应.结果 加用CsA治疗后患者各项指标均较治疗前明显好转,治疗3个月时24 h尿蛋白定量由治疗前的（5.56±2.13）g降至（1.37±1.41） g（P＜0.05）,血浆白蛋白由（24.80±4.69） g/L升至（37.5±5.03） g/L（P＜0.05）,完全缓解9例,部分缓解12例,缓解率67.7％;治疗6个月时24 h尿蛋白定量由治疗前的（5.56±2.13）g降至（0.83±1.21）g（P＜0.05）,血浆白蛋白由（24.80±4.69） g/L升至（41.08±5.64） g/L（P＜0.05）,完全缓解16例,部分缓解11例,无效4例,缓解率87.1％,治疗前后结果差异有统计学意义（P＜0.05）.结论 CsA联合激素治疗可显著减少肾病综合征患者的尿蛋白,且不良反应少,可用于难治性肾病综合征的治疗.

Effectiveness of cyclosporine A combined with prednisone in the treatment of refractory nephrotic syndrome

Objective To investigate the efficacy and safety of cyclosporine A （CsA） together with prednisone in treating refractory primary nephritic syndrome （NS）.Methods Thirty-one patients with refractory NS were treated by CsA combined with prednisone：CsA average starting doses were （1.57 ± 0.25） mg · kg^-1 · day^-1,and prednisone average starting doses were （0.69 ± 0.20） mg· kg^-1 ·day^-1.Before and 1,3 and 6 months after treatment,24 h urine protein,liver function （AST,ALT,Alb）,kidney function （SCr,UA）,blood routine （WBC,Hb,PLT） and blood drug concentration of CsA were detected,and adverse reactions were recorded.Results Each index was improved markedly after combined treatment.After treatment for 3 months,the 24-h urinary protein was decreased from （5.56 ± 2.13） g before treatment to （1.37 ± 1.41） g （P〈0.05）,and serum albumin level was increased from （24.80 ± 4.69） g/L before treatment to （37.5 ± 5.03） g/L （P〈0.05）.Nine cases obtained complete remission,and 12 cases partial remission with the remission rate being 67.7%.After treatment for 6 months,24-h urinary protein was decreased to （0.83 ± 1.21） g （P〈0.05）,and serum albumin was increased to （41.08 ± 5.64） g/L （P〈0.05）.Sixteen cases obtained complete remission and 11 cases partial remission,and 4 had no effect,with the response rate being 87.1%.There was significant difference before and after treatment （P〈0.05）.Conclusions CsA combined with prednisone is effective in the treatment of refractory NS.CsA could reduce the urine protein secretion,and exert no serious adverse reactions in the process of treatment.