他克莫司联合小剂量激素治疗21例儿童激素抵抗型肾病综合征的临床观察

发布时间：2018-03-14 05:20

本文选题：他克莫司　切入点：儿童　出处：《浙江大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的分析评估他克莫司对治疗儿童激素抵抗型肾病综合征的疗效及其安全性。方法采用回顾性纵向研究,分析21例激素抵抗型肾病综合征住院患儿应用他克莫司治疗,初始剂量0.1～0.15mg/(kg·d),每12小时1次,定期监测血药浓度、尿常规、血常规及肝肾功能等指标。同时口服小剂量泼尼松0.2～0.75mg/(kg·d). 结果1-3个月后观察近期疗效,完全缓解者14例,部分缓解者7例,完全缓解率66.7%。16例患儿接受了肾活检,其中6例微小病变型肾病患儿中3例完全缓解,3例部分缓解；4例局灶节段性肾小球硬化患儿中2例完全缓解,2例部分缓解；5例IgM肾病及1例系膜增生性肾小球肾炎患儿均完全缓解。最快显效时间为2天,中位显效时间为18天。服药期间6例患儿出现一过性不良反应,经对症处理后均缓解。治疗期间20例患儿获随访,随访1年内共4例复发；在临床使用他克莫司治疗激素抵抗型肾病综合征患儿达完全缓解1年之后(共7例),共4例6次出现复发。结论他克莫司对儿童激素抵抗型肾病综合征有很好的疗效,服用后不良反应少,大多可耐受,但患儿服药1～2年后复发率较高,是否与患儿本身病情较顽固、药物继发耐药等因素有关,目前不能明确,因此他克莫司治疗激素抵抗型肾病综合征的长期疗效仍有待于进一步随访观察。
[Abstract]:Objective to evaluate the efficacy and safety of tacrolimus in the treatment of steroid-resistant nephrotic syndrome in children. Methods 21 hospitalized children with steroid-resistant nephrotic syndrome were treated with tacrolimus at an initial dose of 0.1 ~ 0.15 mg / kg 路dl, once every 12 hours. Blood routine examination, liver and kidney function, and oral administration of low dose prednisone 0.75 mg / kg / d. Results after 1-3 months, there were 14 cases of complete remission and 7 cases of partial remission. The complete remission rate was 66.7.16 cases received renal biopsy. Of the 6 cases of minimal change nephropathy, 3 cases of complete remission 3 cases of partial remission 4 cases of focal segmental glomerulosclerosis 2 cases of complete remission 2 cases of partial remission of 5 cases of IgM nephropathy and 1 case of Mesangial proliferative glomerular kidney disease. All the children were completely relieved. The most effective time was 2 days. The median effective time was 18 days. Transient adverse reactions were found in 6 children during the course of medication, which were all alleviated after symptomatic treatment. During the treatment, 20 cases were followed up and 4 cases recurred during the 1-year follow-up. One year after tacrolimus was used in the treatment of steroid-resistant nephrotic syndrome (7 cases were treated with tacrolimus, 4 cases recurred 6 times). Conclusion tacrolimus has a good curative effect on steroid-resistant nephrotic syndrome in children. The adverse reactions after taking tacrolimus are few, most of them can be tolerated, but the recurrence rate is higher after taking tacrolimus for 1 ~ 2 years. Drug resistance and other factors are not clear, so the long-term efficacy of tacrolimus in the treatment of steroid-resistant nephrotic syndrome remains to be further followed up.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.9

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