LTAA方案治疗呈肾病综合征的儿童乙型肝炎病毒相关性肾炎

The Effect of LTAA Scheme on Hepatitis B Virus Associated Glomerulonephritis in Children with Nephrotic Syndrome

目的:探讨拉米夫定、雷公藤多苷、血管紧张素转换酶抑制剂及抗凝(LTAA方案)联合治疗儿童乙型肝炎病毒相关性肾炎(HBV-GN)的疗效。方法:以拉米夫定(100mg/d)、雷公藤多苷片(0.5mg.kg-1.d-1)、血管紧张素转换酶抑制剂(洛汀新5～10mg/d)及抗凝治疗7例呈肾病综合征或大量蛋白尿且血HBV-DNA≥1.0×106copy/ml的儿童HBV-GN,疗程12月。结果:6例为膜性肾病、1例膜增生性肾炎。6月时完全缓解(CR)者4例、部分缓解(PR)者3例,有效率57.14%,治疗12月时CR者6例、PR者1例,有效率100%。12月血清HBV-DNA均转阴。12月后停用拉米夫定和雷公藤多苷,继续服用其他药物,随访6～55个月[平均随访(24.1±15.4)个月],血清HBV-DNA3例再次转阳,4例阴性,复发2例,CR者5例、PR者1例、无效(NR)者1例。其中2例出现轻度肝功能异常,保肝治疗后恢复正常。未出现乙型肝炎病毒变异株。结论:LTAA治疗方案是治疗儿童HBV-GN安全有效的方案。

Objective：To observe the effect of combination treatment of Lamivudine, Triperygium Wilfordii, hook T II, Angiotensin- converting- enzyme inhibitor and anticoagulation（ LATT scheme）in children with hepatitis B virus - associated glomerulonephritis. Methods：7 patients of 10- 14 years old with HBV- GN showing nephrotic syndrome or nephrotic proteinuria were treated by lamivudine（100 mg/d）, Triperygium Wilfordii. beok T II（0.5 mg·kg^-1·d^-1 ,lowered after 3 months）, benazepril（5- 10 mg/d）and anticoagulation（ low weight heparin or dipyridamole） simultaneously. The amounts of serum HBV- DNA in thce, e pa- tients was more than 1.0 × 10^6 copy/rnl. Results： The membranous nephropathy was found in 6 cases and menbrano - proliferative glomerulonephritis in 1 cases. After the treatment for 6 month, complete remission（CR） was found in 4 case, partial remission（ PR） in 3 eases. After the treatment for 12 months,CR in 6 eases（CR percentage was 86.71% ）and PR in 1 case and the effective rate was 100%. Serum HBV - DNA was negative in 7 cases. All patients were followed up for 6-55 months （average 24.1 ± 15.4 momths） after the withdrawl of lamivudine and TW, but still receiving the other drugs. During follow - up, Serum HBV - DNA increased again in 3 cases. 2 cases relapse. CR was found in 5 cases, PR in 1 case and no response in 1 case. During the treatment, Hepatic function were found abnormal in 2 cases and recovered to normal after hepatic protective measure. No variant of HBV was found. Concision： The LTAA scheme may be one of safe and effective therapies for HBV- GN in children.