环磷酰胺冲击疗法治疗小儿难治性肾病25例

The Effect of Cyclophosphamide Pulse Therapy in the Treatment of 25 Cases of Refractory Nephrotic Syndrome in Children

目的 :观察环磷酰胺静脉冲击疗法 (CTX PT)治疗小儿难治性肾病 (RNS)临床疗效及血清可溶性白细胞介素 2受体 (sIL 2R)水平变化。方法 :RNS共 5 5例 ,随机分为治疗组 2 5例 ,对照组 3 0例。治疗组接受CTX PT治疗 ,每 2周 1次 ,总累积量为 10 0～ 15 0mg·kg 1 。对照组用环孢素 (CysA) ,5～ 6mg·kg 1 ·d 1 ,bid ,1个月为 1个疗程 ,如无效可增加至 10mg·kg 1 ·d 1 ,再治疗 3个月无效后可停药 ,有效者 6个月后停药。治疗组用ELISA方法测定给药前后血清sIL 2R水平。结果 :治疗组与对照组平均缓解期分别为 ( 3 6.2± 3 .6) ,( 11.6± 3 .8)个月 ,缓解率分别为 72 .0 % ,2 6.7% (均P <0 .0 1)。治疗组 6,18,48个月复发率均比对照组明显降低 (均P <0 .0 1)。CTX PT后血清sIL 2R水平明显下降 (P <0 .0 5或0 .0 1)。结论 :CTX PT对小儿RNS临床疗效较好 ,sIL

Objective:To study the clinical effect of cyclophosphamide pulse therapy(CY PT) in the treatment of refractory nephrotic syndrome(RNS) in children and changes in serum levels of soluble interlukin 2 receptor(sIL 2R). Methods:55 cases of RNS were randomly divided into 2 groups: the treatment groups( n =25) and control group( n =30).Patients of the treatment group were given each fortnightly 10 mg·kg 1 of CY in 100～150 mL of normal saline administered by Ⅳ instillation in 1～1.5 h for 2 consecutive days. This course of treatment was repeated for 6～8 times. The accumulated total dose of CY was within 100～150 mg·kg 1 . Patients of the control group were given each 5～6 mg·kg 1 ·d 1 of cyclosporin A(CysA) for a month. The dose of CysA could be increased to 10 mg·kg 1 q.d. if the effect of the first course was not satisfactory. CysA was discontinued if no effect was obtained after 3 months of treatment. However, the drug was discontinued after 6 months of treatment if the effect proved to be good. Serum levels of sIL 2R were determined with ELISA before and after the CY PT. Results:The average remission stages were 36.2±3.6 and 11.6±3.8 months, and the remission rates were 72.0% and 26.7% in patients of the treatment group and control group, respectively ( P <0.01, P < 0.01 ). The recurrence rates 6, 18 and 48 months after the treatment were significantly lower in patients of the treatment group than those of the control group( P <0.01). The serum sIL 2R level was significantly lowered after the CY PT( P <0.05 or 0.01). Conclusion:CY PT was shown to be fairly effective in the treatment of RNS in children and serum sIL 2R level may be used as an index to monitor the effect of the drug.