钙调磷酸酶抑制剂在儿童难治性肾病综合征中的应用进展

Application of calcineurin inhibitor in children with refractory nephrotic syndrome

环孢素A和他克莫司是钙调磷酸酶抑制剂(calcineurin inhibitors,CNIs)家族主要成员,目前广泛应用于儿童难治性肾病综合征(refractory nephrotic syndrome,RNS)的治疗。环孢素A(cyclosporine A,Cs A)在RNS中应用较早,疗效显著,然而其停药后复发率高,长期使用存在肾损伤风险。他克莫司(tacrolimus,FK506)免疫抑制作用强于Cs A,在儿童RNS中的应用越来越多,但临床对照研究多为小样本,依然存在远期复发率、肾毒性等问题。本文将根据多个临床试验结果对2种药物的疗效、不良反应、药物相互作用以及目前应用存在的问题等多方面进行对比综述,为临床合理用药提供依据。

Cyclosporin A and tacrolimus are the main members of the calcineurin inhibitors（ CNIs）. They are widely used in the treatment of children with refractory nephrotic syndrome（ RNS）. Cyclosporine A（ Cs A） has an earlier application in the RNS with significant effect. However,it has prolonged recurrence rate after drug withdrawal and the risk of renal injury. Additionally,the immunosuppressive effect of tacrolimus（ FK506） was stronger than that of Cs A. At present,studies about tacrolimus in children with RNS are mostly clinical control studies of small samples,and long-term recurrence rate,renal toxicity and other issues are still existed. This article will make a review about the two drugs in the aspects of their efficacy,adverse reactions,drug interactions and other existed problems,which is based on a number of clinical trials to provide a basis for clinical rational drug use.