环孢素A治疗小儿难治性肾病综合征疗效分析

Effect analysis of cyclosporin A in the treatment of children refractory nephrotic syndrome

目的观察环孢素A(CsA)治疗小儿难治性肾病综合征的疗效和不良反应。方法回顾分析31例使用CsA治疗的难治性肾病综合征患儿临床资料,其中激素耐药8例,激素依赖10例,频复发13例;微小病变(MCNS)19例,系膜增生性肾小球肾炎(MsPGN)9例,局灶节段性硬化(FsGS)3例。结果完全缓解19例(61.3%),部分缓解7例(22.6%),无效5例(16.1%)。不同临床类型中,激素依赖型完全缓解率最高(80%),激素耐药型完全缓解率最低(25%),2类型间比较差异有统计学意义(P<0.05)。不同病理类型中,微小病变型完全缓解率最高(68.4%),局灶节段性硬化完全缓解率最低(33.3%),2类型间比较差异有统计学意义(P<0.05)。CsA治疗过程未出现明显的肾毒性反应。结论 CsA治疗小儿难治性肾病综合征安全有效,注意监测血药浓度,肝肾功能情况下,CsA治疗未见严重不良反应。

Objective To evaluate the efficacy of cyclosporine A （CsA） in the treatment of refractory nephrotic syn- drome in children. Methods The clinical data of 31 cases of patients with refractory nephrofic syndrome was analyzed retro- spectively. Among them,8 eases of steroid-resistant NS （SRNS）, 10 cases of steroid-dependent NS （SDNS） and 13 cases of frequent relapse NS （FRNS） were ineluded~ According to the results of renal biopsy, 19 had minimal change nephropathy （MCN）, 3 had focal segmental sclerosis glomerulonephritis （FSGS）, 9 had mesangial proliferative glomeralonephritis （MsPGN）. Results 19 cases was complete remission,7 cases was partial remission and 5 cases was invalid. In different clin- ical types,the total remission rate was 80% in steroid-dependent patients, while the total remission rate was 25% in steroid-re- sistant patients,and the difference was statistically significant （P 〈 0.05 ）. In Different pathological types, the total remission rate was 68.4% in minimal change nephropathy patients,the total remission rate was 33.3% in focal segmental sclerosis glo- merulonephritis patients,and the difference was statistically significant （ P 〈 0.05 ）. No obvious nephric adverse effects were observed during the treatment process. Conclusion CsA is safe and effective in the treatment of children refractory nephrotic syndrome, and there is no severe adverse reaction.