泼尼松联合霉酚酸酯与环孢霉素A治疗儿童激素耐药型肾病综合征的疗效比较

Comparison of therapeutic effects of prednisone combined with mycophenolate mofetil versus cyclosporin A in children with steroid-resistant nephrotic syndrome

摘要:

目的 比较泼尼松联合霉酚酸酯(MMF)与环孢霉素A(CsA)治疗儿童激素耐药型肾病综合征(SRNS)的疗效。方法 收集2004年1月至2013年12月住院并采用泼尼松联合MMF或CsA治疗的164例SRNS患儿的临床资料,回顾性分析泼尼松联合MMF(简称MMF组;n=112)与泼尼松联合CsA(简称CsA组;n=52)治疗儿童SRNS的临床疗效。结果 CsA组治疗后1个月的缓解率为67.3%(35/52),高于MMF组(42.9%,48/112)(P<0.05);CsA组治疗3个月后的缓解率为78.8%(41/52),亦高于MMF组63.3%(71/112)(P<0.05)。MMF组与CsA组的24 h尿蛋白排泄量均随治疗时间变化差异具有统计学意义(P<0.05),MMF组与CsA组之间24 h尿蛋白排泄量存在差别(P<0.05)。两组均无严重不良反应出现。结论 泼尼松联合MMF或CsA治疗儿童SRNS疗效均较好且安全,治疗3个月内CsA优于MMF。

Abstract:

Objective To compare the therapeutic effects of prednisone combined with mycophenolate mofetil(MMF) versus cyclosporin A(CsA) in children with steroid-resistant nephrotic syndrome(SRNS).Methods The clinical data of 164 SRNS children who were treated with prednisone combined with MMF or CsA between January 2004 and December 2013 were collected, and the clinical effect of prednisone combined with MMF(MMF group, 112 children) or CsA(CsA group, 52 children) was analyzed retrospectively.Results At 1 month after treatment, the CsA group had a significantly higher remission rate than the MMF group(67.3% vs 42.9%;P<0.05).At 3 months after treatment, the CsA group also had a significantly higher remission rate than the MMF group(78.8% vs 63.3%;P<0.05).The 24-hour urinary protein excretion in both groups changed significantly with time(P<0.05) and differed significantly between the two groups(P<0.05).There were no serious adverse events in the two groups.Conclusions Prednisone combined with MMF or CsA is effective and safe for the treatment of SRNS in children, and within 3 months of treatment, CsA has a better effect than MMF.