环孢素三联疗法治疗小儿难治性肾病综合征

目的通过检测临床指标的变化,观察应用环孢素（CsA）联合中剂量强的松及地尔硫卓（CsA三联疗法）治疗小儿难治性肾病综合征的临床疗效。方法 2004年10月至2008年10月在河南省人民医院儿科住院的27例难治性肾病综合征患儿运用CsA三联疗法进行治疗。进行1年的随访,在治疗前、治疗后3、6、12个月分别记录24 h尿蛋白定量、尿NAG酶、肝功能（ALT）、肾功能（SCR）及环孢素血药浓度指标的变化,并记录不良反应。应用SPSS 17.0软件进行统计学分析。结果 27例接受CsA三联疗法治疗后20例（74.07%）患儿病情缓解,其中完全缓解14例（51.85%）,部分缓解6例（22.22%）,无效7例（25.93%）。22例患儿进行了肾穿刺活检,MCD 10例总缓解率为90.00%,MsPGN 9例总缓解率为77.78%,3例FSGS缓解1例。病例中23例出现毛发增多的现象,4例齿龈增生,2例出现血压增高现象,4例出现轻微的胃肠道反应,CsA治疗过程未出现明显肾毒性反应。结论应用环孢素三联疗法治疗小儿难治性NS,能明显提高CsA的疗效,减少CsA用量并降低CsA的不良反应,同时能促进肾功能的恢复,改善小儿难治性NS临床检测指标。

Cyclosporine Triple Therapy for Treatment of Children with Refractory Nephrotic Syndrome

Objective By detecting changes in clinical indicators,observe clinical efficacy of cyclosporine（CsA） combined medium dose prednisone,diltiazem（CsA triple therapy） for the treatment of refractory nephrotic syndrome in children.Methods October 2004 to October 2008 in our hospital,27 patients with nephrotic syndrome treated with triple therapy using CsA.To 1 year of follow-up,before treatment,the 3,6,and 12 months after treatment were recorded 24h urinary protein,urinary NAG activity,liver function（ALT）,renal function（SCR） and cyclosporine blood concentration index changes,and record adverse reactions.Application of SPSS 17.0 software for statistical analysis.Results Totally 27 patients received CsA triple therapy,20 patients（74.07%） patients in remission,Complete response in 14 cases（51.85%）,partial remission in 6 cases（22.22%）,ineffective in 7 cases（25.93%）.Children of 22 cases had renal biopsy,MCD 10 patients overall response rate was 90%,MsPGN 9 patients overall response rate was 77.78%,1 of the 3 FSGS relieve.23 cases occurred in the hair growing phenomenon,4 cases of gingival hyperplasia,2 patients had blood pressure phenomenon,4 patients had mild gastrointestinal reaction,CsA treatment has no obvious renal toxicity.Conclusion Cyclosporine triple therapy in children with refractory NS,can significantly improve the efficacy of CsA to reduce CsA dosage and reducing side effects of CsA,while the recovery of renal function and improve clinical testing in children with refractory NS indicators.