ACTH治疗原发性肾病综合征复发患儿的疗效及安全性观察

Clinical efficacy comparison between two treatments of children with relapsed primary nephritic syndrome

目的探讨糖皮质激素(GC)、促肾上腺皮质激素(ACTH)在肾病综合征复发患儿中的疗效及安全性。方法选取激素敏感型原发性肾病综合征患儿为研究对象,其中95例患儿在停用激素后复发或治疗期间复发,将重新采用糖皮质激素治疗或上调激素剂量治疗的患儿纳入GC组,采用ACTH治疗的患儿纳入ACTH组,观察治疗前与治疗期间两组患儿激素用量、临床疗效、不良反应及肾上腺皮质功能变化。结果 ACTH组35例(83.3%)治疗期间未再复发,7例(16.7%)患者因感染导致频繁复发,治疗无效。GC组41例(77.4%)治疗有效,12例(22.6%)单纯激素治疗效果不明显。ACTH组与GC组总有效率无显著差异(P>0.05)。ACTH组患儿GC用量显著高于GC组(P<0.05)、身高增加显著高于高于GC组,体重增加显著高于低于GC组、肾上腺皮质功能降低显著低于GC组(P均<0.05)。结论 ACTH方案治疗原发性肾病综合征复发患儿效果肯定,可降低糖皮质激素使用剂量、改善患儿生长发育的抑制、减轻避免肾上腺皮质功能降低。

Objective To investigate the efficacy and clinical significance of adrenocorticotropic hormone on the treatment of children with relapsed primary nephrotic syndrome（ PNS） . Methods Children enrolled in this study all met the diagnostic criteria of PNS char-acterized by steroid-dependent and relapse. These children were assigned into GC group and ACTH group based on different treatments. The hormone dose,clinical efficacy,adverse reactions and adrenocortical function were compared between two groups. Results Thirty-five children（83. 3%） had improved and 7 children（16. 7%） relapsed due to infection in ACTH group, while forty-one children （77. 4%） had improved and 12 children（22. 6%） relapsed in GC group. The efficacy had no obvious difference between two groups （P〉0. 05）. The dosage of hormone used in GC group was higher than ACTH group during treatment（P〈0. 05）. In ACTH group dos-age of hormone could be successfully reduced till stop of using. The ratio of height and the ratio of weight increased greater in ACTH group than GC group while adrenocortical function decreased slower in ACTH group than GC group. Conclusions ACTH treatment had obvious clinical efficacy,which could reduce the dosage of GC and improved the children＆#39;s growth and development.