儿童难治性肾病综合征环磷酰胺冲击治疗对血清IgG的影响

The effect of CTX pulse therapy on the plasma IgG in children with obstinate nephrotic syndrome

目的 :探讨环磷酰胺 (CTX)治疗儿童难治性肾病综合征 (ONS)的疗效及治疗前后血清IgG水平与其治疗效应之间的关系。方法 :肾病综合征 (NS)诊断明确后 ,用药前取血测定IgG水平 ,激素敏感患者在尿蛋白转阴后再采血检测血清IgG ,难治性肾病综合征患者 ,激素治疗四周尿蛋白不转阴 ,激素方案不变 ,同时应用环磷酰胺冲击治疗 ,环磷酰胺治疗量达到总量的二分之一时重新评估治疗效果 ,并同时检测血IgG ,将三次检测结果以及正常同龄儿血清IgG值比较。结果 :肾病综合征患者血清IgG水平低于正常同龄儿 ,激素敏感患者血清IgG水平在尿蛋白转阴后升高 ,激素及环磷酰胺治疗尿蛋白转阴血清IgG水平升高 ,与治疗前相比有显著性差异 ,与正常同龄儿比较无显著性差异 ,尿蛋白持续不转阴者血清IgG持续低水平 ,同治疗前比较无显著性差异 ,同激素敏感型比较差异显著。结论

Objective To explore the therapeutic effect of CTX on the children with obstinate nephrotic syndrome (ONS) and the relationship between the level of plasma IgG before and after CTX pulse therapy and the therapeutic effect.Method The serum IgG was detected by immune transmission before treatment after the children with nephrotic syndrome were (NS) diagnosed.The serum IgG was detected once again when uric protein became negtive with steroid-sensistive nephrotic syndrome(SSNS),or when uric protein couldn't become negtive with glucocorticoid therapy for four weeks.The treatment with glucocorticoid didn't change,meanwhile,these children were given CTX pulse thearpy at the same time to evaluate therapeutic effect again and detected serum IgG when CTX got to a one half of total-dose.We compared the three serum IgG with those of normal children of the same age.Result The serum IgG in the children with NS was lower than that in normal children group.The level of plasma IgG was increased when the uric protein become negtive in children with SSNS.Plasma IgG was significantly higher than that before treated with glucocorticoid and CTX therapy,but no showed signifcant difference compared with that of normal children.The serum IgG remained low in children whose uric protein had never changed to negative and showed no significant difference comparing with before treatment but there was significant difference in children with SSNS.Conclusion The disease has a relationship between therapeutic effect in NS children and serum IgG.