糖皮质激素加重对激素不敏感儿童肾病蛋白尿

Glucocorticoids Enhanced Proteinuria in Children with G Cs Resistant Nephrotic Syndro me

目的：有报道糖皮质激素（ Ｇ Ｃｓ） 亦可加重肾脏病蛋白尿。本课题旨在探讨 Ｇ Ｃｓ 是否加重激素不敏感肾病综合征（ Ｎ Ｓ） 蛋白尿及其机制，以指导临床合理使用 Ｇ Ｃｓ。方法：１９ 例对激素不敏感的 Ｎ Ｓ 患儿予泼尼松每日１５ ～２ ｍｇ／ｋｇ 隔日早上０８∶００ 顿服。同时检测激素日和无激素日的尿蛋白及其成分、白蛋白和免疫球蛋白 Ｇ 及肌酐的清除率、肾有效血浆流量（ Ｅ Ｒ Ｐ Ｆ） 、尿前列腺素等并进行比较。结果：与无激素日比较，激素日尿蛋白明显增加（２４ ｇ ±０５ ｇ ｖｓ １５ ｇ ±０４ ｇ／２４ ｈ ， Ｐ ＜００１） ，其中以尿白蛋白、 Ｉｇ Ｇ 增加为主，尿β２微球蛋白无明显变化。激素日的内生肌酐清除率、白蛋白清除率及 Ｉｇ Ｇ 清除率亦明显增高，３ 例 Ｅ Ｒ Ｐ Ｆ在激素日均高于无激素日，而尿血栓素 Ｂ２ 和６酮前列腺 Ｆ１ａ 、血清总蛋白、白蛋白和 Ｉｇ Ｇ 均无明显改变。结论： Ｇ Ｃｓ 可能通过增加肾小球滤过膜的通透性及改变肾小球血流动力学，而加重激素不敏感的 Ｎ Ｓ患儿的蛋白尿；其加重蛋白尿机制并非通过肾前列腺素系统；对 Ｇ Ｃｓ 疗效不可靠的 Ｎ Ｓ 患者，不宜长期、大剂量使用 Ｇ Ｃｓ 。

Objective : It has been reported that Glucocorticoids( G Cs) can increase urinary protein excretion . Thepurpose of this subject was to investigate whether G Cs rise proteinuria and underlying the mechanism in children withnephrotic syndrome( N S) . Method :19 nephrotic children who were resistantto prednisone therapy were treated with al ternate day administration of 1 5 ～2 mg/kg·d - 1 of prednisone . Urinary protein , endogenons creatinine clearance rate( Ccr) ,effective renal plasma flow( E R P F) ,urinary prostaglandins were examined on prednisone day and nonprednisoneday . Results : The urinary protein excretion on prednisone day was significantly higherthan nonprednisone day (2 4 g ±0 5 g vs 1 5 g ±0 4 g/24 h , P < 0 01) . Further urinalysis domonstrated the proteinuria mainly contains albumin and Ig G, but not β2 M G. Similarly ,clearance rate of cr ,albumine and Ig Gincreased remarkably on prednisone day . Thedata also demonstrated that E R P Ewas higher on prednisone day with three patients . However ,no significant changes inurinary T X B2 ,6 keto P G F1a ,serum total protein , albumin and Ig G were found on prednisone day and nonprednisoneday . Conclusions : Taking togetherthese findings suggested that G Cs may enhance proteinuriain patients with G Cs resis tant N Sby increasing glomerular permeability and changing glomerular hemodynamics which might notcontribute to renalprostaglandins system , Long term with large doses of G Cstreatmentfor the patient who is G Cs resistant N Sis notrecom mended .