Hari Pankaj, Bagga Arvind, Mantan Mukta
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.
Indian Pediatr. 2004 Oct;41(10):993-1000.
To compare the short term efficacy of intravenous pulses of methylprednisolone and dexamethasone in treatment of steroid resistant nephrotic syndrome in children.
We prospectively treated 81 children with idiopathic steroid resistant nephrotic syndrome with six alternate-day pulses of intravenous dexamethasone (5 mg/kg) or methylprednisolone (30 mg/kg). Fifty-nine patients received dexamethasone and 22 were treated with methylprednisolone. Two patients in dexamethasone and one in methylprednisolone group developed serious infection during administration of alternate-day pulses and could not complete the therapy.
The median age at treatment was 38 (36-74.7) months. Of patients who completed therapy, 20 (35.1 percent) (95 PERCNT CI 22.9-48.9) and 7 (33.1 percent) (95 percent CI 14.6-56.9) patients in dexamethasone and methylprednisolone group, respectively achieved complete remission. Following alternate day pu1ses the median urinary albumin to creatinine ratio decreased from 9.2 to 1.5 (P less tha 0.005) in dexamethasone group and from 12.1 to 0.7 (P less than 0.005) in methylprednisolone group. The median reduction in urinary albumin to creatinine ratio was 54.1 PERCNT (95 percent CI 32.7- 83.9) and 63.2 percent (95 percent CI 23.5- 100) in dexamethasone and methylprednisolone group respectively. The chief side effects of therapy were transient hypertension or worsening of preexisting hypertension, which occurred in 31 (54.4 percent) patients in dexamethasone group and 10 (47.6 percent) in the methylprednisolone group. The hypertension was satisfactorily controlled on antihypertensive drugs. One or more side effects were observed in 66.7 percent (95 percent CI 52.9-78.6) children receiving dexamethasone therapy and 61.9percent (95 percent CI 38.4-81.9) receiving methylprednisolone, which was comparable.
We conclude that intravenous dexamethasone is as effective as methylprednisolone in inducing remission in patients with steroid resistant nephrotic syndrome.
比较甲泼尼龙和地塞米松静脉冲击治疗儿童激素抵抗型肾病综合征的短期疗效。
我们前瞻性地对81例特发性激素抵抗型肾病综合征患儿进行治疗，采用六次隔日静脉注射地塞米松（5mg/kg）或甲泼尼龙（30mg/kg）。59例患者接受地塞米松治疗，22例接受甲泼尼龙治疗。地塞米松组有2例患者、甲泼尼龙组有1例患者在隔日静脉注射治疗期间发生严重感染，无法完成治疗。
治疗时的中位年龄为38（36 - 74.7）个月。在完成治疗的患者中，地塞米松组和甲泼尼龙组分别有20例（35.1%）（95%可信区间22.9 - 48.9）和7例（33.1%）（95%可信区间14.6 - 56.9）患者实现完全缓解。隔日静脉注射后，地塞米松组尿白蛋白肌酐比值中位数从9.2降至1.5（P<0.005），甲泼尼龙组从12.1降至0.7（P<0.005）。地塞米松组和甲泼尼龙组尿白蛋白肌酐比值的中位数降低分别为54.1%（95%可信区间32.7 - 83.9）和63.2%（95%可信区间23.5 - 100）。治疗的主要副作用是短暂性高血压或原有高血压恶化，地塞米松组有31例（54.4%）患者出现，甲泼尼龙组有10例（47.6%）患者出现。高血压通过降压药物得到满意控制。接受地塞米松治疗的儿童中有66.7%（95%可信区间52.9 - 78.6）、接受甲泼尼龙治疗的儿童中有61.9%（95%可信区间38.4 - 81.9）观察到一种或多种副作用，二者相当。
我们得出结论，静脉注射地塞米松在诱导激素抵抗型肾病综合征患者缓解方面与甲泼尼龙同样有效。
