Nakayama Masaru, Katafuchi Ritsuko, Yanase Tetsuro, Ikeda Kiyoshi, Tanaka Hiroshi, Fujimi Satoru
First Department of Internal Medicine, Fukuoka Red Cross Hospital, Fukuoka, Japan.
Am J Kidney Dis. 2002 Mar;39(3):503-12. doi: 10.1053/ajkd.2002.31400.
To clarify factors influencing the response to corticosteroids and subsequent relapses, 62 Japanese adult patients with minimal change nephrotic syndrome were analyzed retrospectively. Five patients experienced remission spontaneously. Fifty-three patients entered complete remission, 3 patients entered partial remission, and 1 patient showed no response to corticosteroids. Fifty-three patients with complete remission were divided into two groups: 38 early responders who experienced remission completely within 8 weeks after starting treatment and 15 late responders who experienced remission after 8 weeks. Blood urea nitrogen and serum creatinine levels and proteinuria selectivity index at presentation were significantly worse in late than early responders. Relative interstitial volume determined by the point-counting method was significantly greater in late than early responders. Relative interstitial volume showed significant correlations with blood urea nitrogen, serum creatinine, and proteinuria selectivity index values. Thirty-three patients experienced a relapse; 13 patients experienced multiple relapses. Fifty-three patients with remission were divided into three groups: 16 patients who experienced relapse within 6 months after the initial response (early relapsers), 17 patients who experienced relapse after 6 months (late relapsers), and 20 patients who did not experience relapse (nonrelapsers). Mean age at onset was younger in early relapsers than late or nonrelapsers. Age at onset correlated inversely with relapse rate in 53 patients with remission and correlated positively with timing of the first relapse in 33 relapsers. It thus was suggested that impaired renal function and poor selectivity of proteinuria, which might be related to interstitial edema, were factors influencing a slower response to corticosteroids. Younger patients had a greater incidence of relapse and were prone to experience relapse earlier.
为了阐明影响对皮质类固醇反应及随后复发的因素，我们对62例日本成年微小病变型肾病综合征患者进行了回顾性分析。5例患者自发缓解。53例患者完全缓解，3例患者部分缓解，1例患者对皮质类固醇无反应。53例完全缓解的患者分为两组：38例早期缓解者在开始治疗后8周内完全缓解，15例晚期缓解者在8周后缓解。就诊时晚期缓解者的血尿素氮、血清肌酐水平及蛋白尿选择性指数明显比早期缓解者差。采用点计数法测定的相对间质容积晚期缓解者明显大于早期缓解者。相对间质容积与血尿素氮、血清肌酐及蛋白尿选择性指数值显著相关。33例患者复发；13例患者多次复发。53例缓解患者分为三组：16例在初次缓解后6个月内复发的患者（早期复发者），17例在6个月后复发的患者（晚期复发者），20例未复发的患者（未复发者）。早期复发者的发病平均年龄比晚期复发者或未复发者年轻。发病年龄与53例缓解患者的复发率呈负相关，与33例复发患者首次复发的时间呈正相关。因此提示，肾功能受损及蛋白尿选择性差，可能与间质水肿有关，是影响对皮质类固醇反应较慢的因素。年轻患者复发率较高且易于较早复发。
