他克莫司与大剂量甲泼尼龙冲击治疗婴幼儿激素耐药型肾病综合征的疗效及安全性

Tacrolimus and High-Dose Methylprednisolone in the Treatment of Infantile Hormone-Resistant Nephrotic Syndrome

目的:比较他克莫司与大剂量甲泼尼龙冲击治疗婴幼儿激素耐药型肾病综合征的疗效及安全性,为临床治疗提供参考。方法:选择2014年1月至2017年4月在海口市第三人民医院肾内科接受治疗的50例激素耐药型肾病综合征患儿作为研究对象,随机分为对照组和观察组各25例。对照组患儿采用甲泼尼龙冲击治疗,观察组患儿采用他克莫司口服治疗,比较两组患儿的疗效、不良反应及复发情况等。结果:观察组患儿总缓解率、完全缓解率均高于对照组(χ~2分别为6. 522、10. 659,P<0. 05)。随访6个月,两组患儿尿蛋白定量均减少,且治疗1、3、6个月观察组患儿尿蛋白定量均少于对照组(P<0. 05)。治疗12个月后观察组患儿T淋巴细胞计数均下降(P<0. 05),而12个月与6个月比较T淋巴细胞计数差异无统计学意义(P>0. 05)。两组患儿的感染率及复发率比较差异无统计学意义(P>0. 05)。结论:他克莫司治疗婴幼儿激素耐药型肾病综合征具有良好的临床疗效,且复发情况少、药物安全性高,值得临床推广应用。

Objective： To compare the efficacy and safety of tacrolimus and high-dose methylprednisolone in the treatment of infantile hormone-resistant nephrotic syndrome,so as to provide reference for the clinical treatment. Methods： Totally 50 cases with infantile hormone-resistant nephrotic syndrome admitted into the Third People＇s Hospital of Haikou from Jan. 2014 to Apr. 2017 were selected to be randomly divided into control group and observation group, with 25 cases in each group. The control group received methylprednisolone pulse therapy,while the observation group was given orally tacrolimus. The efficacy,adverse drug reactions and recurrence of two groups were compared. Results： The total remission rate and complete remission rate of observation group were significantly higher than those of control group（ χ^2 were respectively 6. 522 and 10. 659,P〈0. 05）. After 6 months of follow-up,the urinary protein in two groups decreased significantly,and the urine protein in observation group was significantly less than that in control group at 1,3 and 6 months,respectively（ P〈0. 05）. After 12 months of treatment,the T lymphocyte counts of observation group decreased significantly（ P〈0. 05）,yet there was no significant change in T lymphocyte counts between 12 months and 6 months（ P〈0. 05）.There was no statistically significant difference in the infection rate and recurrence rate between two groups（ P〉0. 05）. Conclusion：Tacrolimus has good clinical efficacy in the treatment of infantile hormone-resistant nephrotic syndrome with lower recurrence rate and higher safety of medication,it is worth further popularizing in clinical treatment.