甲泼尼龙冲击治疗小儿肾病综合征型过敏性紫癜肾炎疗效观察——附13例分析

目的：探讨甲泼尼龙冲击治疗肾病综合征型过敏性紫癜肾炎患儿的疗效。方法：肾病综合征型过敏性紫癜肾炎患儿24例，分为甲泼尼龙冲击治疗组（激素冲击组，13例）和泼尼松口服治疗组（激素口服组，11例）。2组患儿均同时使用环磷酰胺冲击治疗及常规应用双嘧达莫，在此基础上，激素冲击组予甲泼尼龙冲击治疗（甲泼尼龙剂量每次15～30mg／kg，隔日1次，共6次），之后予口服泼尼松1．5～2．0mg／（kg·d），4周后减量。如患儿治疗3个月、5个月时蛋白尿仍未缓解，则再次予甲泼尼龙冲击治疗。激素口服组则无应用甲泼尼龙冲击治疗。观察患儿治疗1个月、2个月、3个月、4个月、5个月的尿常规结果，以尿蛋白和尿红细胞定性作为衡量蛋白尿和血尿的指标。结果：激素冲击组治疗1个月的尿蛋白减少总有效率为92％，明显高于激素口服组的总有效率45％（P〈0．05），且该组治疗2个月、治疗3个月的尿蛋白减少的显效率分别为67％和91％，均明显高于激素口服组的18％和3／9（均为P〈0．05）。对血尿疗效方面，激素冲击组在治疗1个月、2个月显效分别为1例、2例，总有效率分别为31％、75％，而口服激素组在治疗1个月、2个月无显效病例，总有效率分别为36％、36％。结论：对于肾病综合征型过敏性紫癜肾炎患儿，甲泼尼龙冲击治疗与口服泼尼松治疗比较，前者可以更快缓解蛋白尿和血尿。

Effect of methylprednisolone pulse therapy for Henoch-Sch(o)nlein purpura nephritis with nephritic syndrome in children

Objective： To study the effect of methylprednisolone pulse therapy on Henoch-Schonlein purpura nephritis （HSPN） with nephritic syndrome in children. Methods： Twenty-four children of HSPN with nephritic syndrome were enrolled in this study. Children were divided into 2 groups： steroid pulse therapy group（ SP group, n = 13 ）, and steroid oral therapy group （ SO group, n = 11 ）. Cyclophosphamide pulse therapy and regular dipyridamole were given in both groups. Methylprednisolone （15 -30 mg/kg, given every other day for 6 times） was given to children in SP group. Prednisone 1.5 - 2. 0 mg/（ kg · d） was given for other 4 weeks and then tapered. If proteinuria was non-remission at the 3rd and 5th month, methylprednisolone pulse therapy was repeated. Methylprednisolone was not given to children in SO group. Routine urine test was performed before steroids therapy and one month to five months after the starting of steroids therapy. The qualitation of the urinary protein and red blood cells were performed. Results ： One month after the starting of steroid therapy, the total effective rate of proteinuria decreasing was 92% in SP group, significantly higher than that of 45% in SO group（ P 〈 0.05 ）, two and three months after the starting of steroids therapy, excellence rates of proteinuria decreasing were 67% and 91% in SP group, 18% and 3/9 in SO group respectively. The differences between the two groups were significant（both P 〈 0. 05 ）. For hematuria decreasing, marked effectiveness were seen in 1 case and 2 cases, and total effective rates were 31% and 75% respectively in the first month and the second month in SP group, whereas marked effectiveness was not seen in SO group, with a total effective rate of 36% and 36% in the first month and the second month respectively. Conclusion： Mythelprednisolone pulse therapy reduces proteinuria and hematuria faster than prednisone oral therapy for HSPN with nephritic syndrome in children.