免疫抑制剂治疗儿童紫癜性肾炎的进展

Progress of immunosuppressive agents in the treatment of henoch-schonlein purpura nephritis in children

免疫抑制剂是治疗重症紫癜性肾炎(HSPN)的主要药物,糖皮质激素作为基础用药,对急性期HSPN效果明显,大剂量冲击治疗时疗效更佳。环磷酰胺疗效较肯定,其他免疫抑制剂包括硫唑嘌呤、环孢素A、吗替麦考酚酯、咪唑立宾、来氟米特,在治疗肾病水平蛋白尿、激素抵抗以及其他重型HSPN有一定疗效。雷公藤多苷有减少蛋白尿和降低激素用量的作用。目前,HSPN尚缺乏公认的特效治疗方法,新型免疫抑制剂为治疗HSPN提供了更多选择,但尚需更多大样本的随机对照研究。

Immunosuppressive agents are the main therapeutic strategies for severe Henoch-Schonlein purpura nephritis （HSPN） , glucocorticoid is the first-line treatment for HSPN, especially for rapid progressive nephritis. Cyclo- phosphamide is proved effective. The other immunosuppressive agents include azathioprine, ciclosporin A, mycopheno- late mofetil, mizoribine and leflunomide, which have some effects on nephrotic-range proteinuria, steroid-resistant and other severe HSPN. Tripterygium glycosides can reduce proteinuria and reduce the dosage of glucocorticoid. Without an accepted and specific treatment currently, the new immunosuppressive agents offer more choices to treat HSPN, but still need more large sample randomized controlled trials （RCTS） to study.