环磷酰胺静脉冲击治疗儿童激素依赖性肾病综合征32例疗效分析

Effect of cyclophosphamide impulsive therapy on children with steroid-dependent nephrotic syndrome.

目的 了解大剂量环磷酰胺静脉冲击疗法 (CTX PT)治疗儿童激素依赖性肾病的近期疗效以及影响疗效的相关因素。方法 总结 1991年 9月至 2 0 0 0年 6月接受CTX PT治疗的激素依赖性肾病 3 2例 ,并就其疾病类型、临床观察指标等与疗效的关系进行了分析。结果 ①用CTX PT治疗 2 3例有效 (有效率 71 9% )。②影响疗效的因素主要有疾病的临床、病理类型以及血清肌酐 (SCr)水平。单纯性肾病疗效明显好于肾炎性肾病(有效率分别为 85 0 %和 5 0 0 % ,P<0 0 5 ) ;病理表现为微小病变 (MCNS)者明显好于非MCNS ;SCr水平在治疗前较高者提示可能疗效也差。CTX PT疗效与性别、发病年龄、血清白蛋白、球蛋白、血胆固醇、免疫球蛋白、2 4h尿蛋白排泄量等无关 (P >0 0 5 )。③毒副作用 :11例 (3 4 4% )未见明显CTX毒副作用 ;2 1例 (65 6% )出现不同程度的副作用 ,主要为急性胃肠道反应占 40 6% (3d内缓解 ) ,其它副作用少见 ,而且这些毒副作用均为一过性并很快恢复正常。结论 CTX PT治疗儿童激素依赖性肾病有效率为 71 9% ,影响疗效的因素主要有疾病的临床、病理类型以及SCr水平等。

Objective To investigate the short term effect of cyclophosphamide impulsive therapy(CTX PT)and its relevant factors on children with steroid dependent nephrotic syndrome(SDNS).Methods Clinical and therapeutic efficacy data were analyzed in 32 patients with SDNS.Results ①CTX PT was effective in 23 cases (71 9%).②Serum creatinine (Cr), clinical and pathological types of SDNS could affect this effect. The regimen was more effective in patients with simple nephropathy than those with nephritic nephropathy (85 0% and 50 0% respectively,P<0 05), and minimal change nephrosis (MCNS) than non MCNS. No correlation was found between the efficacy and the age, Alu, Glb, Ch, IgG, IgM, IgA and urinary protein excretions (P>0 05). Adverse events:No adverse effect was found in 11 cases (34 4%), while varied degree of adverse events showed in 21 cases (65 6%), most of which (40 6%) were gastrointestinal reactions.Conclusions CTX PT achieved 71 9% efficacy in patients with SDNS.Cr level,clinical and pathological types of SDNS could affect this effect.