他克莫司联合低剂量激素治疗儿童难治性肾病综合征临床疗效(附16例报告)

目的：探讨他克莫司联合低剂量醋酸泼尼松治疗儿童难治性肾病综合征（RNS）的临床疗效和安全性，并观察地尔硫卓对他克莫司血药浓度的影响。方法：选择儿科住院的RNS患儿16例，应用他克莫司（0.10~0.15 mg·kg^-1·d^-1）联合低剂量醋酸泼尼松（1.0~2.0 mg·kg^-1·d^-1）治疗，监测患儿治疗过程中他克莫司浓度，记录患儿治疗前及治疗后2、4、8、12和24周时的24 h尿蛋白定量（UP）、血浆白蛋白（Alb）和肌酐等6项指标。结果：16例患儿中完全缓解9例，部分缓解5例，无效2例，总有效率94%。治疗24周后，16例患儿24 hUP较治疗前明显降低（Z=-3.516，P<0.01）；血浆Alb水平较治疗前明显升高（Z=-3.516，P<0.01）。治疗2周时患儿总胆固醇和甘油三酯水平较治疗前明显下降（Z=-2.223，P<0.05；Z=-3.464，P<0.01）。8例患儿出现他克莫司血药浓度偏低，给予地尔硫卓后血药浓度均提升至有效浓度范围。患儿在治疗过程中肌酐和尿素氮等指标均在正常范围内平稳波动。结论：他克莫司联合低剂量激素的免疫抑制方案治疗儿童RNS安全有效，地尔硫卓能够有效提高他克莫司的血药浓度。

Clinical efficacy of tacrolimus combined with low dose of corticosteroids in treatment of children with refractory nephritic syndrome:A report of 16 cases

Objective:To observe the clinical efficacy and safety of tacrolimus(TAC) combined with low dose of corticosteroids in the treatment of the children with refractory nephrotic syndrome(RNS),and to investigate the effect of diltiazem on the blood concentration of TAC. Methods:A total of 16 hospitalized children with refractory nephrotic syndrome(RNS)were selected.All patients were treated with TAC(0.10-0.15 mg·kg^-1·d^-1)combined with low dose of corticosteroids(l.0-2.0 mg·kg^-1·d^-1).The concentrations of TAC of the children during the treatment process were monitored.The 24 h urine protein quantitative(UP),plasma albumin (Alb),creatinine and other 6 indexes were recorded before treatment and 2,4,8,12 and 24 weeks after treatment. Results:In 16 cases,9 cases were completely relieved,5 cases were partially relieved,and 2 cases were invalid;the total efficiency was 94%.The 24 h UP of 16 children at 24 weeks after treatment was significantly decreased compared with before treatment(Z=-3.516,P<0.01);the plasma Alb level of the children was significantly increased compared with before treatment(Z=-3.516,P<0.01).The total cholesterol and triglyceride levels at 2 weeks after treatment were decreased significantly compared with before treatment(Z=-2.223,P<0.05;Z=-3.464,P<0.01).Eight patients had low blood concentration of TAC,and it was increased to an effective concentration after treated with diltiazem.In the course of treatment,creatinine,urea nitrogen and other indexes of the patients were fluctuated in a normal range. Conclusion:TAC combined with low dose of corticosteroids for treatment of RNS is safe and effective,and diltiazem can effectively increase the blood concentration of TAC.