他克莫司联合小剂量激素治疗儿童激素抵抗型肾病综合征的临床研究

目的探讨他克莫司联合小剂量激素治疗儿童激素抵抗型肾病综合征的临床疗效。方法选取本院2007年4月～2010年9月收治的儿童激素抵抗型肾病综合征患者26例,随机分为两组,采用他克莫司治疗患者13例为对照组,采用他克莫司联合小剂量激素治疗患者13例为观察组,治疗疗程均为6个月,比较两组患者治疗后的临床指标。结果治疗后,观察组与对照组胆固醇、三酰甘油、尿蛋白均明显下降,肌酐、白蛋白均明显升高。观察组胆固醇、三酰甘油、尿蛋白均明显低于对照组,肌酐、白蛋白均明显高于对照组,差异均有统计学意义（P〈0.05）。观察组与对照组血糖均略有升高,观察组血糖略高于对照组,观察组他克莫司血药浓度略低于对照组,观察组病症总缓解率略高于对照组,差异均无统计学意义（P〉0.05）。观察组不良反应发生率和复发率均明显低于对照组,差异均有统计学意义（P〈0.05）。结论他克莫司联合小剂量激素治疗儿童激素抵抗型肾病综合征具有显著的临床疗效,可以明显改善患者的临床生化指征并减少尿蛋白,降低并发症发生率和复发率,操作简单且安全可靠,值得临床推广使用。

Clinical study on Tacrolimus and small dose of hormone in the treatment of children with steroid resistant nephrotic syndrome

Objective To investigate the clinical efficacy of Tacrolimus and small dose of hormone in the treatment of children with steroid resistant nephrotic syndrome.Methods 26 children with steroid resistant nephrotic syndrome in the hospital from April 2007 to September 2010 were selected and divided into two groups randomly.13 patients who used Tacrolimus were taken as the control group.13 patients who used Tacrolimus combined with small dose of hormone were taken as the observation group.The course of treatment was 6 months.Clinical indexes were compared between two groups.Results After treatment,cholesterol,triglyceride,urinary protein in the observation group and the control group were significantly decreased,while creatinine and albumin were significantly elevated.Cholesterol,triglyceride,urinary protein in the observation group were significantly lower than those in the control group.Creatinine,albumin in the observation group were significantly higher than those in the control group.The difference was statistically significant(P < 0.05).Blood glucose in the observation group and the control group were slightly elevated.Blood glucose in the observation group was higher than that in the control group.Blood concentration of Tacrolimus in the observation group was lower than that in the control group.Overall remission rate of symptoms in the observation group was higher than that in the control group.There were no significant differences between them(P > 0.05).The incidence of adverse reactions and recurrence rate in the observation group were significantly lower than those in the control group,while the difference was statistically significant(P < 0.05).Conclusion Tacrolimus combined with small dose of hormone used in the treatment of children with steroid resistant nephrotic syndrome has significant clinical curative effect,which can significantly improve patients clinical biochemical indications and decrease urine protein.That can reduce the incidence of complication and recurrence rate,which is simple operation,safe and reliable,and worthy of clinical use.