长春新碱对激素依赖型肾病综合征的治疗

目的：目前对于激素依赖型肾病综合征的治疗仍较困难,我们回顾性地评价了长春新碱对用过环磷酰胺治疗后而仍有复发的激素依赖型肾病综合征患儿的治疗效果。方法：14例口服过一个疗程以上环磷酰胺而仍有复发的激素依赖型肾病综合征患儿接受了长春新碱治疗。长春新碱的用法为每周静脉注射1次,连用4周,然后每月1次,连用4月,每次剂量为1~1.5 mg/m2。结果：13例完成了长春新碱的整个疗程。正处于肾病复发期的8例患儿,6例(75%)完全缓解,蛋白尿在用长春新碱治疗2~3剂后消失。在疗程结束后对处于肾病缓解状态的12例患儿随访,发现4例(33.3%)未再复发,持续保持缓解9~40月(中位数为13.5月);半年内的肾病复发次数由治疗前的1.67次降至0.67次(P<0.05);8例再复发者,7例再次注射长春新碱(1 mg/m2)1~2剂后蛋白尿均消失。除用1.5 mg/m2剂量时腹痛较显著外患儿未出现其他明显副作用。结论：长春新碱能诱导激素依赖型肾病综合征复发患儿的完全缓解,还有可能降低复发频率。对于再复发患儿,少数几次长春新碱的使用可能优于口服一个疗程的泼尼松龙或环孢素。[中国当代儿科杂志,2005,7(6):495-498]

Therapeutic effect of vincristine on steroid dependent nephrotic syndrome

OBJECTIVE: The treatment of steroid-dependent nephrotic syndrome (SDNS) remains a challenge.This study evaluated the efficacy of vincristine(VCR) in children with SDNS who had relapses after cyclophosphamide treatment. METHODS: The clinical data of 14 children with SDNS between June 2000 and March 2003 were studied retrospectively. They had relapses after more than one course of cyclophosphamide treatment before VCR treatment.VCR was administered by intravenous boluses in a dose of (1.0-1.5) mg/m~2 once weekly for 4 weeks then once monthly for 4 months. RESULTS: Thirteen patients completed the full course of VCR treatment and one patient discontinued after 6 times of VCR injection because of frequent relapses during the VCR treatment.Six of the 8 patients in relapse achieved complete remission after 2-3 times of VCR injection. After completing the full course of VCR treatment,12 patients achieved remission. Four remained in remission for the median time of 13.5 months (range 9-40 months). Seven of the 8 patients who continued to relapse received another VCR treatment (1 mg/m~2). After 1 or 2 infusions of VCR their proteinuria disappeared. Compared with before VCR treatment, the relapse frequency in half a year post-VCR treatment was decreased from 1.67 to 0.67 time (P<0.05). Side effects related to VCR treatment were uncommon. Only 3 patients presented with abdominal pain, but the symptom was alleviated after the dosage was reduced from 1.5 mg/m~2 to 1.0 mg/m~2. CONCLUSIONS: VCR treatment can induce complete remission of relapse and decrease the relapse frequency in children with SDNS.A few additional doses of VCR infusions may be effective in patients after a full course of VCR treatment but continue to relapse later.