摘要
目的观察吗替麦考酚酯（MMF）与环磷酰胺（CTX）联合糖皮质激素治疗儿童紫癜性肾炎（HSPN）的疗效。方法回顾性分析48例紫癜性肾炎（HPSN）患儿临床资料，中位随访时间22（7，48）个月。根据治疗方案的不同分为2组：MMF组（MMF15—20mg·kg^-1·d^-1或800—1200mg／m^2＋泼尼松）和CTX组（CTX8—12mg·kg^-1·d^-1＋泼尼松）。收集患儿基线临床和肾脏病理资料，及接受治疗后1、3、6个月的临床资料和实验室检查结果。统计随访期间HSPN累计缓解率、复治率和不良反应。研究的主要终点为完全缓解和失访，次要终点为蛋白尿缓解。结果共计48例患儿完成随访，MMF组34例，CTX组14例。两组患儿治疗后1、3、6个月时，24h尿蛋白量均较基线值明显下降；血清白蛋白（Alb）均较基线值明显升高（均P〈0．05），血清肌酐（Scr）与基线值的差异无统计学意义。治疗1个月后，MMF组缓解率高于CTX组（73．5％比42．9％，P=0．046），治疗3、6个月及随访结束时的累计缓解率两组比较差异均无统计学意义。至随访结束，48例缓解患儿有5例（10．4％）复治，MMF组的复治率明显低于CTX组（3．0％比28．6％，P〈0．001）。复治多发生在泼尼松及CTX停药后和MMF减量过程中。MMF组11例患儿接受了IMPDH2基因多态性检测，9例AA型患儿治疗显效时间明显早于AG型和GG型。至随访结束，MMF组患儿不良反应发生率明显低于CTX组（8．8％比35．7％，P=0．025），用药过程中两组均有真菌感染发生。结论MMF与CTX冲击治疗儿童紫癜性肾炎的近期疗效相当，MMF组复治率及不良反应发生率低于CTX组。初步研究发现IMPDH2基因多态性与MMF疗效及不良反应发生有关。
Objective To explore the effect and safety of mycophenolate mofetil （MMF） and glueocorticoid on Henoch-Schonlein purpura nephritis in children and compared with cyclophosphamide （CTX）. Methods The data of 48 patients diagnosed as Henoch- Schonlein purpura by renal biopsy were retrospectively analyzed. Median follow-up time was 22（7, 48） months. The subjects were divided into 2 groups. 34 cases were in the MMF group： MMF （15-20 mg·kg^-1·d^-1 or 800-1200 mg/m^2）＋ prednisone, and 14 eases in the CTX group： CTX （8 - 12 mg ·kg^-1·d^-1） ＋ prednisone. Clinical and laboratory data were collected at baseline and 1, 3, 6 months after treatment. During follow- up, cumulative retreatment rate and adverse reactions after treatment were recorded. Results In two groups after treatment for 1, 3, 6 months, 24 hours urinary protein quantitative was significantly lower than the baseline value, serum albumin （sAlb） was significantly higher than the baseline value, and serum creatinine （Scr） indicated no statistically significant difference during the follow-up period. After the treatment of 1 month, the efficient rate of MMF group was higher than the CTX group （MMF 73.5 % vs 42.9%, P=0.046）, the effective treatment of 3, 6 months at the end of the follow-up, no statistically significant difference were observed in the accumulative remission rate. The total rate of retreatment was 10.4% （5/48）, where MMF group was lower that of the than CTX group （3.0% vs 28.6%, P 〈 0.001）. The retreatment often occurred after discontinuation of prednisone and CTX, MMF reduction process. Eleven children received IMPDH2 gene polymorphisms test in MMF group, 9 AA children had shorter time for drugs to be effective than that of the AG and GG children. The incidence of adverse reactions of MMF group was obviously lower than CTX group at the end of the follow-up （8.8% vs 35.7%, P--0.025）, where two groups developed fungal infection. Conclusions The short-term effect of both groups are the same, but the recurrent rate and incidence of adverse reactions of MMF group are lower than those of the CTX group. The preliminary study shows that IMPDH2 gene polymorphisms is associated with MMF curative effect and adverse reactions.
出处
《中华肾脏病杂志》
CSCD
北大核心
2017年第9期670-677,共8页
Chinese Journal of Nephrology
关键词
紫癜性肾炎
儿童
吗替麦考酚酯
环磷酰胺
Henoch-Sehonlein purpura, children
Mycophenolate mofetil
Cyclophosphamide
