他克莫司较其它免疫抑制剂在儿童难治性肾病综合征中疗效比较

Tacrolimus Compared with Other Immunosuppressants in Children with Refractory Nephrotic Syndrome

摘要: 儿童难治性肾病综合征(Refractory nephropathy syndrome, RNS)影响着数以万计的儿童，发病率因种族和地点而异。检索文献发现近年来对于该疾病的治疗是一个巨大挑战。RNS常导致的最终结局为进行性肾功能衰竭，并且在治疗中通常存在与毒性相关的并发症、死亡率和成本问题从而变得复杂。为努力改善RNS患儿预后，同时考虑持续缓解和减少不良反应的问题，以下几种免疫抑制剂，如霉酚酸酯(MMF)、环孢菌素(CsA)、他克莫司(TAC)、环磷酰胺(CTX)和利妥昔单抗(RTX)、左旋咪唑(LMS)等已单独或结合世界各地儿童肾脏专科疾病中的广泛差异使用，因此结果各不相同。其中TAC疗效尤为突出，虽然有不少文献将TAC与各类免疫抑制剂进行两两疗效对比，但没有综合性归纳，因此，本文将对TAC与其他免疫抑制剂在治疗儿童RNS上的疗效做一个综合性论述。

Abstract: Refractory nephropathy syndrome (RNS) affects tens of thousands of children, with rates varying by ethnicity and location. A search of the literature found that the treatment of the disease has been a major challenge in recent years. RNS often leads to progressive renal failure, which is often compli-cated by toxicity-related complications, mortality, and cost. In an effort to improve the prognosis of children with RNS, while considering sustained remission and reduction of adverse effects, the fol-lowing immunosuppressants, such as mycophenolate mofetil (MMF), cyclosporine (CsA), tacrolimus (TAC), cyclophosphamide (CTX) and rituximab (RTX), levamisole (LMS), etc., have been used alone or in combination with wide differences in specialist diseases of the kidney of children around the world, so the results vary. Among them, the efficacy of TAC is particularly prominent, although there are many literature comparing the efficacy of TAC with various immunosuppressants, but there is no comprehensive summary, therefore, this article will make a comprehensive discussion of the ef-ficacy of TAC and other immunosuppressants in the treatment of RNS in children.