他克莫司和吗替麦考酚酯分别联合激素治疗肾病综合征患儿疗效比较

目的 比较他克莫司(FK506)与吗替麦考酚酯(MMF)分别联合激素治疗儿童激素依赖肾病综合征/频复发肾病综合征(SDNS/FRNS)的临床疗效。 方法 回顾分析2009年1月—2015年7月浙江大学医学院附属儿童医院收住的49例SDNS/FRNS患儿,FK506组有21例,28例MMF组患儿根据霉酚酸曲线下面积(MPA-AUC)分为低浓度组MPA-AUC<30μg/(ml·h)]和高浓度组MPA-AUC≥30μg/(ml·h)],比较各组治疗效果。 结果 (1)激素用量:随访半年,各组激素用量均明显减少,同初始激素用量比较有统计学差异,P<0.01;其中MMF高浓度组激素用量最少,同低浓度组相比,有统计学差异,P<0.05。随访1年组间激素用量无明显差异,P>0.05。(2)复发次数:随访半年,各组复发次数明显减少,除低浓度组外,其他各组同治疗前比较均有统计学差异,P<0.05;其中MMF低浓度组平均反复次数最多,同高浓度组相比有统计学差异,P<0.05。随访1年组间平均反复次数无统计学差异,P>0.05。 结论 FK506与MMF联合激素治疗SDNS/FRNS患儿临床疗效差异无统计学意义;随访半年时MMF高浓度组治疗效果最佳,MMF低浓度组治疗效果最差。MMF低浓度组患儿如半年未出现频反复,完成1年随访,与其他组临床效果无差异。 

Clinical efficacy of tacrolimus/mycophenolate mofetil combined with steroid on children with nephrotic syndrome

Objective To compare the clinical efficacy of tacrolimus (FK506) and mycophenolate mofetil (MMF) combined with steroid respectively in the treatment of steroid dependent/frequent relapsing nephrotic syndrome (SDNS/FRNS) in children. Methods Forty-nine cases of Children with SDFN/SDNS from January, 2009 to July, 2015 were recruited, 21 cases in tacrolimus group, 28 cases in mycophenolate mofetil group, and the 28 cases were divided to MMFlow-concentration groupMPA-AUC < 30 μg/(ml·h)]and MMF-high-concentration groupMPA-AUC ≥ 30 μg/(ml·h)]according to the area under the curve of mycophenolic acid (MPA-AUC). The therapeutic effect of the groups were compared. Results (1) Steroid dosage:The steroid dose was reduced more significantly at 6-month follow-up (P <0. 01). The MMF-high-concentration group's was reduced the most, and it had significant difference compared with MMFlow-concentration group (P < 0. 05). No significant difference among the groups hormone dosage at 12-month follow-up (P > 0. 05). (2) Relapse episodes:The number of relapse episodes was reduced more significantly at 6-month follow-up (P < 0. 05) except MMF-low-concentration group. MMF-low-concentration group had the most number of relapse episodes during 6-month follow-up, and the result was significantly compared with MMF-high-concentration group (P < 0. 05). No significant difference occured in the relapse episodes of the groups at 12-month follow-up (P > 0. 05). Conclusion There is no significant difference in the clinical efficacy between FK506 and MMF combined with steroid respectively in the treatment of children with SDNS/FRNS. After 6 months of treatment, MMF-high-concentration can obtain a satisfactory therapeutic effect. For the children receiving low concentration MMF, the clinical effect can be similar with other patients if the disease did not frequently relapse in one year.