长效丙酮缩去炎舒松治疗肾病综合征6～10年随访观察

Six to Ten Years Follow-Up Survey of Triancinolone Acetonide Therapy in Children with Nephrotic Syndrome

目的观察长效丙酮缩去炎舒松(T-A)替代口服泼尼松在小儿肾病综合征(NS)维持治疗中的远期疗效。方法原发性NS25例(单纯型10例,肾炎型15例)。采用泼尼松治疗4～8周诱导缓解,未缓解者加用免疫抑制剂诱导缓解后改为隔日晨口服。减量2周,予小剂量T-A(0.5～1.0mg/kg)深部肌肉注射,第1年1次/月,次年隔月1次,其中8例频复发者,第3年每3个月1次,另17例第3年停肌肉注射T-A2周后停服泼尼松。观察T-A治疗前、治疗期间25例NS患儿的临床表现、尿常规、血生化改变及T-A治疗停药后6～10a其抗复发效果及不良反应。采用SPSS10.0软件进行统计学分析。结果1.T-A治疗剂量:平均剂量0.97mg/(kg.次),总剂量18.1mg/kg(13.5～24.4mg/kg)。2.T-A治疗前予泼尼松口服长程疗法治疗,16例复发;T-A用药2a期间仅7例复发,2组复发率比较有显著性差异(P<0.05)。3.T-A治疗第2、3年各2例复发,复发率与第1年的5例复发比较,无显著性差异(P>0.05)。4.T-A治疗停药后追踪观察6～10a,仅4例复发,与用T-A治疗前16例复发比较,有显著性差异(P<0.05)。结论T-A治疗过程与停药后的复发率低于常规泼尼松口服的复发率,且未见明显不良反应。用小剂量T-A替代口服泼尼松维持治疗小儿NS可减少复发,是简便安全的疗法。

Objective To observe the long term effects of triancinolone acetonide （ T - A） as a substitution for prednisone, a maintenance therapy in treating children with nephrotic syndrome（NS）. Methods Twenty - five children with idiopathic NS（ 10 children with simple type NS and 15 children with nephritic type NS）. Prednisone treatment for 4 -8 weeks would bring remission,and immunosupression was added if remission failed. Then oral prednisone was reduced to 2 mg/kg per alternate day for 2 weeks, followed by a small dose of T - A （ 0.5 - 1.0 mg/kg） intramuscular injection,once a year per month for the first year, and every other month for the second year, as for the 8 frequently relapse eases,it would be every 3 months for the third year,other 17 cases stopped T-A intramuscular injection in the third year. Two weeks after T- A treatment stopped using prednisone. The relapse and the side -effects was observed through the observation of 25 NS children＇s clinical manifestation, routine urine test, and biochemistry variation before and during the T - A treatment, along with a 6 to 10 years follow - up survey after T - A therapy stopped. Statistical analysis was performed by using SPSS 10.0 software. Results 1. Median dose of T - A Was 0.97 mg/kg per time ,total doses of T- A was 18.1 mg/kg（ 13.5 -24.4 mg/kg）. 2. There were 16 relapse cases by prednisone treatment ,while 7 relapse eases by T - A treatment for 2 years,there existed a significant comparison （ P 〈 0. 05 ）. 3. There were 2 relapse cases in the second and the third year of T - A treatment. Compared with the 5 cases in the first year, there was no significant difference in the rate of relapse （ P 〉 0. 05 ）. 4. There were only 4 relapsed cases in the 6 - 10 years of follow - up observation ,the difference was sharp compared with the 16 relapsed cases before T - A treatment （ P 〈 0.05 ）. Conclusions The rate of relapse for T - A treatment, no significant side - effects can be found, is lower than that of prednisone treatment. It is both simple and comparatively safe to use small dose of T - A instead of prednisone treatment in maintaining remission and reducing relapse for children with NS.