阿奇霉素治疗儿童原发性肾病综合征反复或复发效果探讨

Effects of Azithromycin on Recurrence or Relapse of Primary Nephrotic Syndrome in Children

目的探讨儿童原发性肾病综合征(PNS)在糖皮质激素(GC)减量过程中出现反复和(或)复发现象时阿奇霉素的干预作用。方法 179例PNS反复或复发的患儿随机分为治疗组和对照组,治疗组予口服阿奇霉素,剂量10mg/(kg·d),3d为1个疗程;对照组予非大环内酯类抗生素治疗。对其年龄、性别、体质量、反复或复发情况、总病程、GC的每日用量及累积应用总时间、24h尿蛋白定量(24h-Upro)、血总蛋白(Tp)、白蛋白(Alb)、胆固醇(Tcho)、尿素氮(Bun)、肌酐(Scr)、免疫球蛋白(IgA、IgG、IgM、IgE)、补体(C3、C4)及血支原体IgM抗体阳性比例等临床特征、血尿生化指标进行单因素分析及多因素Logistic回归分析。结果治疗组与对照组患儿以及治疗组中阿奇霉素有效患儿与无效患儿一般资料及血尿监测指标比较差异均无统计学意义。治疗组有效率(75.28%)高于对照组(34.44%),差异有统计学意义。治疗组中阿奇霉素有效与无效患儿的就诊前尿蛋白定性程度和就诊前尿蛋白持续天数差异均有统计学意义。Logistic回归分析显示,治疗前尿蛋白持续时间越短阿奇霉素干预有效率越高。结论在PNS患儿出现反复或复发现象的早期予以阿奇霉素干预治疗可得到较好的疗效,阿奇霉素有可能作为GC的助减剂为反复或复发的PNS患儿提供一种新的治疗选择。

Objective To explore the intervention effect of azithromycin on recurrence and （or） relapse caused by glu- cocorticoid （GC）reduction in children with primary nephrotie syndrome （PNS）. Methods One hundred and seventy-nine patients with relapse/recurrence of PNS were randomly divided into treatment group and control group. Patients were treated with azithromycin 10 mg/kg/day, 3 days for a course in treatment group. Patients in control group were given non-macrolide antibiotics. The clinical and laboratory data including age, gender, weight, repeated/recurrence condition, the total duration of PNS, the daily dosage and the cumulative total application time of GC, 24 h urine protein quantitative （24 h - Upro）, blood to- tal protein （Tp）, albumin （Alb）, cholesterol （Tcho）, urea nitrogen （Bun）, serum creatinine （Scr）, immune globulin （IgA, IgG, IgM and IgE）, complement （C3 and C4） and blood mycoplasma IgM antibody positive ratio, were analyzed by single and multi- pie regression analysis. Results There were no significant differences in clinical and laboratory data between treatment group and control group and between azithromycin effective group and azithromycin ineffective group. There was significant difference in the efficiency between treatment group （75.28%） and control group （34.44%）. There were also significant differ- ences in the urinary protein qualitative degree and the duration of urine protein before the treatment between the azithromycin effective group and azithromycin ineffective group. The non-conditional logistic regression analysis showed that the higher ef- ficiency appeared with the shorter duration of urinary protein before treatment.Conclusion Azithromyein is effective in the early stage of PNS relapse/recurrence in children. Azithromycin may be used as a steroid-sparing medicine to provide a new treatment option in PNS children with relapse or recurrence.