他克莫司治疗儿童难治性肾病12例临床研究

Effects of Tacrolimus in Children with Intractable Nephrotic Syndrome: A Study of 12 Cases

目的:观察他克莫司(TAC)治疗儿童激素耐药性肾病综合征(SRNS)和狼疮性肾炎(LN)的疗效及不良反应。方法:前瞻性研究10例SRNS以及2例狼疮性肾炎(IV型)患儿,10例SRNS包括微小病变型肾病(MCD)2例、系膜增生性肾小球肾炎(MsPGN)6例、局灶节段性肾小球硬化(FSGS)2例。研究开始时给予泼尼松2 mg/kg隔天1次口服,维持4周并逐渐减量,同时服用TAC,根据TAC血药浓度调整剂量,定期随访肝肾功能、24 h尿蛋白等生化指标。结果:12例患儿在TAC治疗后均有不同程度缓解,开始缓解时间为12～62 d,随访时间7～18个月,完全缓解率为83.33%;平均尿蛋白从(105.00±25.25)mg/(kg.d)降至(3.89±2.34)mg/(kg.d)(P<0.01),血浆白蛋白从(19.33±2.96)g/L升至(31.76±4.52)g/L,差异均有统计学意义(P<0.01)。结论:TAC治疗难治性肾病能得到较为满意的缓解效果且不良反应少。

Objective： To observe the effect and side effect of Tacrolimus （TAC） in the treatment of steroid-resistant nephrotic syndrome （SRNS） and lupus nephritis （ LN, class IV）. Methods： Prospective study of 10 SRNS and 2 LN children. 10 SRNS children including 2 minimal change nephropathy （MCD）, 6 minimal change nephropathy （MsPGN）, 2 Focal Segmental Glomerulous Sclerosis （FSGS）. All children were started on oral Prednisone 2 mg/mL once every other day and reduced gradually after 4 weeks. At the same time took TAC. Followed the biochemical criterion of liver and kidney function, 24 h urine protein. Results： Twelve children had a different mitigation after taking TAC, the time to mitigation is 12-62 days and follow-up time is 7-18 months, complete remission rate was 83.33%. Average urinary protein decreased from （ 105.00 ± 25.25 ） mg/（ kg d） to （3.89 ± 2.34 ） mg/（ kg d ）, serum albumin increased from （ 19.33±2.96 ） g/L to （ 31.76± 4.52 ） g/L, the differences were statistically significant （ P 〈 0.01 ）. Conclusions： Tacrolimus is effective in the treatment of steroid-resistant nephrotic syndrome and lupus nephritis.