亚硒酸钠及维生素E治疗小儿肾病综合征远期疗效分析

Long-term effects of sodium selenite and vitamin E treatment on nephrotic syndrome in children

目的评价亚硒酸钠及维生素E(VitE)治疗小儿肾病综合征(NS)远期疗效。方法57例NS患儿在常规使用激素的基础上,37例(NS组)服用亚硒酸钠,0.5mg／d,连服1周,以后每周0.5mg,同时服VitE,50mg／次,3次／d,疗程6个月;20例为对照组。观察两组患儿治疗前后血清硒(Se)、血浆谷胱甘肽过氧化物酶(GSH-Px)活力、丙二醛(MDA)及血清免疫球蛋白等指标,随访1.6-7.5年,观察其远期疗效。结果NS组血清Se含量及GSH-Px活力明显增加(P<0.01),MDA显著降低(P<0.05),免疫球蛋白恢复正常。完全缓解NS组33例(89.19％),对照组6例(30.00％);NS组复发3例(9.09％),对照组复发4例(66.67％)。NS组远期疗效显著优于对照组(P<0.05),复发率显著低于对照组(P<0.05)。结论用亚硒酸钠及VitE治疗NS患儿,可提高缓解率,降低复发率;Se含量减少,免疫球蛋白合成不足可能是NS容易感染引起复发的原因之一。

Objective To evaluate long-term effects of sodium selenite and vitamin E(VitE) treatment on nephrotic syndrome (NS) in children. Methods 37 children with NS,based on glucocorticoid routine therapy,were combined with sodium selenite at a dose of 0.5mg/day for one week and then a dose of 0.5mg/week for 6 months. In the meantime, VitE at a dose of 50mg three times daily was also administered for 6 months.20 children with NS served as controls were treated only with glucocorticoid routine therapy.Serum selenium (Se),plasma glutathione peroxidase (GSH-Px) .plasma malondialdehyde (MDA) and serum immunoglubulin levels were determined before and after treatment. During 1.6-7.5 years of following-up study,the therapeutic effects in two groups were being observed. Results After treatment,Se and GSH-Px levels in NS group were significantly higher than those in controls (P<0.01). In NS group,MDA level was lower obviously(P<0.05),but serum im-munoglobulin level returned to normal. Complete remission rate were 89.18% and 30.00% ,relapse rate were 9.09% and 66.67% in NS and in control groups respectively,with significant difference between two groups (P<0.05). After sodium selenite and VitE treatment,complete remissin rate increased and relapse rate decreased. Conclusions Reduction of Se may be one of the mechanism in patients with NS liable to infection and relapse.