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

摘要: 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。

Abstract: 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 oc-curred 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.