环磷酰胺与雷公藤多甙治疗儿童难治性肾病综合征疗效比较

环磷酰胺与雷公藤多甙治疗儿童难治性肾病综合征疗效比较

【摘 要】 目的 观察环磷酰胺与雷公藤多甙治疗幅童难治性肾病综合征疗效、不良反应和复发率。方法 难治性肾病综合征患儿55例，随机分成两组，环磷酰胺（CTX）组30例：给予CTX 8～12 mg/kg静脉滴注，1次/d，连用2天为1个疗程，每2～4周应用1个疗程，连用6～10个疗程，累积量小于200 mg/kg；雷公藤多甙（TⅡ）组25例：给予TⅡ1 mg/(kg·d)，分3次口服，每天最大量30 mg，疗程3个月。所有患儿给予泼尼松1 mg/(kg·d)，分3次口服，4周后改为隔日顿服，并逐渐减量，其余用药相同。结果 环磷酰胺组疗效优于雷公藤多甙组（χ2=4．30，P＜0．05），近期不良反应少，复发率低（χ2=4．86，P＜0．05）。结论 环磷酰胺冲击治疗儿童难治性肾病综合征，适于在基层首选使用。

【关键词】 环磷酰胺；雷公藤多甙；冲击治疗；儿童；难治性；肾病综合征

Comparison between the therapeutic effects of cyclophosphamide and tripterygium wilfordii hook on children′s refractory nephrotic syndromeSONG Bing．Department of Pediatrics，Dazhu Country People′s Hospital of Sichuan Province，Dazhu，635100，China【Abstract】 Objective To observe the therapeutic effects，the side-effects and the relapse ratio of cyclophosphamide and tripterygium wilfordii hook on children′s refractory nephrotic syndrome．Methods 55 patients were randomly divided into two groups：the cyclophosphamide(CTX) group with 30 patients and the tripterygium wilfordii hook (TⅡ) group with 25 patients．The CTX patients were given CTX8～12 mg/kg of venous inflow once a day and two days′ treatment was a treatment period which was given every 2～4 weeks，The patients had 6～10 treatment courses with the accumulation of less than 200 mg/kg；The TII patients took orally 1 mg/(kg·d) of TII three times every day with 30 mg per day at the most，The treatment period was three months．All the patients took orally 1 mg/(kg·d) of prednisone three times every day，and 4 weeks later took it once every other day，reducing the medicine amount gradually．The rest of the medicine they took were the same．Results The therapeutic effects of the CTX group were better than those of the TⅡ group(χ2=4．30,P＜0．05 with obvious difference) with fewer side-effects in short term and with lower relapse ratio(χ2=4．86,P＜0．05,obvious difference)．Conclusion The ictus treatment of cyclophosphamide on children′s refractory nephrotic syndromewas fit to be adopted as basic level．【Key words】 Cyclophosphamide；Tripterygium wilfordii hook；Ictus treatment；Children；Refractory；Nephrotic syndrome

原发性肾病综合征（PNS）为小儿时期肾脏常见疾病之一，大部分对糖皮质激素敏感，治疗效果好，但一部分成为难治性肾病综合征（RNS），包括激素耐药（SR）性、激素依赖(SD)性及频复发(FR)性NS，严重影响患儿及家属身心健康，目前以糖皮质激素联合其他免疫抑制剂治疗为主。我们选用环磷酰胺与雷公藤多甙联合泼尼松治疗儿童难治性肾病综合征，比较两者疗效、不良反应及复发