硫普罗宁致肾病综合征的报告分析

Analysis of tiopronin-induced nephrotic syndrome

目的：探讨硫普罗宁导致肾病综合征的特点及治疗，为临床安全用药提供参考。方法：经查阅相关文献，对硫普罗宁引起肾病综合征患者的临床病理特点、治疗预后等进行总结，并对我院收治的2名因使用硫普罗宁导致肾病综合征患者的实际情况进行分析。结果：文献报道29例硫普罗宁引起的肾病综合征病例，其中，男性16例，女性13例；年龄最小20个月，最大73岁；用药1月～2年的患者有14例；9例行肾活检，以膜性肾病为主（6例）；29例患者中给予激素治疗者3例，免疫抑制荆治疗者1例，其他给予对症支持治疗者25例，所有患者均恢复正常，完全恢复时间小于5周。我科收治2例患者，男女各1名，年龄分别为76岁和62岁，院外抗结核常规给予硫普罗宁保肝治疗，分别在用药9、11周后出现大量蛋白尿、低蛋白血症，临床诊断肾病综合征；1例肾活检病理诊断肾小球微小病变，未给予激素及免疫抑制剂治疗，停用硫普罗宁后1—2个月肾病自行缓解。结论：硫普罗宁长期应用可以导致肾病综合征，病理类型表现多样，多数停药后可自行缓解。建议长期使用该药的患者应注意肾脏损害，早期发现及时停药，预后较好。

Objective： To describe the clinical course and management of tiopronin-induced nephrotic syndrome, and provide reference for the safe use of tiopronin. Methods： Nephrotic syndrome cases induced by tiopronin were collected and analyzed in respect of the distribution of gender and age, occurrence time, the primary diseases, renal pathology. The two patients with tiopronin treated in our hospital were reviewed too. Results： There were 29 cases reported from 1978 to 2011, including 16 male and 13 female. Fourteen cases （48.27%） were treated for 1 month to 2 years with tiopronin. Renal biopsy was performed in 9 cases, six cases were membranous nephropathy. The two cases in our hospital were 62 years old women and 76 years man. After 9-11 weeks treatment of tiopronin, nephrotic syndrome occurred. The nephrotic syndrome remissed in 1-2 month after tiopronin withdrawal. There was glomerular minor lesion in one patient in our hospital. Conclusion： Long-time application of tiopronin can induce nephrotic syndrome. Weekly urine checks should be proposed in patients treated with tiopronin.