霉酚酸酯联合激素治疗儿童紫癜性肾炎的临床研究-东南大学学报医学版

霉酚酸酯联合激素治疗儿童紫癜性肾炎的临床研究

单位：1. 南京军区南京总医院儿科, 江苏南京 210002;
2. 南京医科大学附属南京明基医院儿科, 江苏南京 210019

分类号：R692.34

出版年·卷·期（页码）：2013·32·第四期（404-408）

摘要：

目的: 探讨伴有新月体的儿童紫癜性肾炎(HSPN)的治疗新方法。方法: 对33例伴有新月体的儿童HSPN进行临床分型及病理分级,患儿予大剂量甲基泼尼松龙冲击、泼尼松、霉酚酸酯等治疗。结果: 33例HSPN患儿分为4种临床类型:(1) 孤立性蛋白尿1例(3.0%);(2) 血尿和蛋白尿15例(45.5%);(3) 急性肾炎型4例(12.1%);(4) 肾病综合征型13例(39.4%)。病理分级:32例为Ⅲ级,即系膜增生,伴有<50%肾小球新月体形成;1例Ⅴ级,中~重度系膜增生伴88%肾小球新月体形成。经新方案治疗后,33例HSPN患儿完全缓解30例,占91%,好转2例,死亡1例,其完全缓解率明显高于以往接受常规治疗的患儿。结论: 儿童HSPN伴有新月体者使用大剂量甲基泼尼松龙冲击治疗+序贯泼尼松+霉酚酸酯治疗,其疗效好于以往常规治疗方案。

Objective: To study the new therapy for Henoch-Schonlein purpura nephritis(HSPN) in children accompanied by crescent formation. Methods: 33 HSPN children were divided into 4 clinical types and 5 histological degrees respectively. All patients were treated with high-dose mythylprednisolone pulse therapy, prednisone, mycophenolate mofetil, etc. Results: 33 HSPN children were divided into 4 clinical types:(1) isolated proteinuria, 1 case(3.0%);(2) hematuria and proteinuria, 15 cases(45.5%);(3) acute nephritis type, 4 cases(12.1%);(4) nephrotic syndrome type, 13 cases(39.4%). About histological degrees, 32 cases were in grade Ⅲ(mesangial proliferation, all accompanied by <50% crescent formation), 1 case was in grade Ⅴ(moderate to severe mesangial proliferation, accompanied by 88% crescent formation). Treated with new therapy, 30 cases(91%) were complete remission, 2 cases were improved, and one died. The complete remission rate of this therapy was significantly higher than that of the past treatment. Conclusion: Treated with high-dose mythylprednisolone pulse therapy, prednisone, mycophenolate mofetil etc, HSPN children accompanied by crescent formation have better effects compared with the past treatment.

参考文献：

[1] WHITE R H R. Henoch-Schonlein nephritis: a disease with significant late sequelae[J]. Nephron,1994,68(1):1-9.
[2] CAMERON J S. Henoch-Schonlein purpura: clinical presentation[M]. Contr Nephrol(Karger,Basel),1984,40:246-249.
[3] GOLDSTEIN A R, WHITE R H R, AKUSE R, et al. Long-term follow-up of childhood Henoch-Schonlein nephritis[J].Lancet,1992, 339(FEB1):280-282.
[4] 中华医学会儿科学分会肾脏病学组.小儿肾小球疾病临床分类、诊断及治疗[J]. 中华儿科杂志,2001,39(12):746-749.
[5] 谢红浪.过敏紫癜性肾炎诊断及治疗规范[J]. 肾脏病与透析肾移植杂志,2004,13(4):358-359.
[6] 樊忠民,刘光陵,夏正坤,等. 儿童与成人紫癜性肾炎临床分型、病理及及预后比较研究[J]. 山西医科大学学报,2005,36(6):758-761.
[7] 杨静霞,黄松明,吴红梅,等. 儿童紫癜性肾炎180例临床与病理分析[J]. 中国实用儿科杂志,2009,24(5):390-392.
[8] HALLING S F, SODERBERG M P, BERG U B. Henoch-Schonlein nephritis: clinical findings related to renal function and morphology[J]. Pediatr Nephrol,2005,20(1):46-51.
[9] 黎磊石, 刘志红. 中国肾脏病学[M]. 北京: 人民军医出版社, 2008: 1888-1890.
[10] HUANG Y H, LIU Z H, HUANG H D, et al. Effects of mycophenolic acid on endothelial cells[J]. Int Immunophamacol, 2005, 5(6):1029-1039.
[11] 傅君,杨莉娅,陈俊峰,等. 霉酚酸酯治疗IgA肾病疗效研究的Meta分析[J]. 东南大学学报:医学版,2011,30(6): 849-854.
[12] 林炯程,胡伟新,唐政,等. 霉酚酸酯与环磷酰胺治疗重症过敏紫癜性肾炎的疗效比较[J]. 肾脏病与透析肾移植杂志,2005,14(6):508-513.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录