吗替麦考酚酯治疗小儿频复发肾病综合征的疗效观察

目的：观察和评价吗替麦考酚酯（MMF）对儿童频复发性肾病综合征（FRNS）的疗效及安全性.方法：2006年12月至2013年6月期间我院收治的FRNS患儿共35例,予足量泼尼松治疗,诱导缓解后激素逐渐减量,同时开始口服MMF,剂量为20～40 mg/（kg·d）,治疗6个月若无效则停药,有效则减量维持.观察药物的疗效及不良反应.结果：MMF治疗后随访6个月,33例复发率从治疗前的3.34（2.49,5.50）次/6个月,降为0.00（0.00,1.00）次/6个月（P＜ 0.001）.治疗后随访7～12个月,30例复发率从治疗前3.14 （2.40,5.00）次/6个月降为0.00（0.00,1.00）次/6个月（P＜0.001）.治疗后随访13 ～18个月,23例复发率从治疗前3.34（2.57,6.00）次/6个月降为1.00 （0.00,1.20）次/6个月（P＜ 0.001）.治疗后随访18个月以上,17例复发率从治疗前3.34 （2.49,6.00）次/6个月降为0.60 （0.00,1.05）次/6个月（P=-0.007）.同时泼尼松得以逐渐减量（P＜0.001）.治疗过程中,1例出现腹痛,1例并发急性阑尾炎,2例感冒次数增加,1例并发尿路感染,1例出现肌肉震颤,未发现血液系统及肝肾功能损害.结论：MMF是治疗儿童FRNS的一种有效、安全的免疫抑制剂.

Observation on curative effect of mycophenolate mofetil on frequently relapse nephrotic syndrome in children

Objective： To observe and evaluate the efficacy and safety of mycophenolate mofetil （MMF） on frequently relapse nephrotic syndrome （FRNS） in children. Methods： Thirty-five patients with FRNS were chosen for observation. Prednisolone was administered 2.0 mg/kg per day and reduced gradually after remis- sion. MMF 20 - 40 mg/kg daily in two divided doses after relapse was therefore commenced and this treatment continued for at least 6 months. MMF was abandoned if proved ineffective or continued with a gradually reduc- ing dose if not. Urinalysis, complete blood counts, biochemistry and adverse effects were supervised during the treatmeant. Results： Mean 6-monthly relapse rates decreased significantly from 3.34 （2.49, 5.50） episodes before MMF therapy to 0.00 （0.00, 1.00） episodes in the first 6 months in 33 patients （P〈0.001）, from 3.14 （2.40, 5.00） episodes before MMF therapy to 0.00 （0.00, 1.00） episodes in the next 6 months in 30 patients （P〈0.001）, from 3.34 （2.57, 6.00） episodes before MMF therapy to 1.00 （0.00, 1.20） episodes in 13th-18th month in 23 patients （P〈0.001）, and from 3.34 （2.49, 6.00） episodes before MMF therapy to 0.60 （0.00, 1.05） episodes in 17 patients who followed-up for more than 18 months. Prednisolone dosage was tapering during the treatment （P〈0.001）. Adverse effects observed were as the following： one patient had transient abdominal pain, one had got acute appendicitis, two had more cold than usual, one got urinary tract infection and one had a muscle tremor phenomena. No patients were found suffering from hematological abnormalities, impaired renal or hepatic function. Conclusion： MMF is an effective and safe immunosuppressant for children with FRNS.