他克莫司对肾病综合征型紫癜性肾炎的治疗观察

Treatment of Tacrolimus on Nephrotic Syndrome with Henoch-Schonlein Purpura Nephritis

目的:评价他克莫司(FK506)治疗儿童肾病综合征型紫癜性肾炎(HSPN)的疗效和安全性。方法:选取符合入选标准的43例患儿,应用FK506联合激素治疗,分别于治疗前和治疗后1、2、3月观察各项指标变化,包括24 h尿蛋白定量、尿素氮(BUN)、血肌酐(Scr)、血清白蛋白(Alb)及总胆固醇(TC)。结果:治疗后各项临床生化指标明显改善,差异均有统计学意义(P <0.05),且随着治疗时间延长,改善程度越明显。轻度胃肠道反应7例,腹泻3例,均于1周内消失;肝功能异常1例,FK506减量后肝功能恢复正常。结论:FK506联合激素治疗肾病综合征型HSPN,可以减少蛋白尿、降低高血脂,多数得到缓解,认为此治疗取得了明显疗效,且安全性较好。

Objective:To evaluate the efficacy and safety of tacrolimus in the treatment of nephrotic syndrome with Henoch-Schonlein purpura nephritis in children.Methods:43 children who met the inclusion criteria were selected and treated with the tacrolimus and steroid combination therapy.The indicators were tested before treatment and 3 months later,including the 24 h urinary protein excretion,blood urea nitrogen(BUN),serum creatinine(Scr),plasma albumin(Alb)and total cholesterol(TC).Results:Tacrolimus combined with steroid therapy had significant effects.The clinical and biochemical indicators improved significantly after treatment(P<0.05),and with the treatment time,the degree of improvement was more obvious.Mild gastrointestinal reaction occurred in 4 cases and diarrhea in 2 cases,all disappeared within 1 week.Liver dysfunction occurred in 1 case,and the function returned to normal with drug dose reduction.Conclusion:The tacrolimus and steroid combination therapy for nephrotic syndrome with Henoch-Schonlein purpura nephritis can reduce proteinuria and high cholesterol;and the majority of children get complete remission.This combined treatment has achieved significant efficacy and better safety.