Czupryniak Aneta, Kałuzyńska Anna, Tkaczyk Marcin, Półtorak-Krawczyk Anna, Ostrowski Bartosz, Wiecek Bogusław, Nowicki Michał
Klinika Nefrologii i Dializoterapii, Instytut Centrum Zdrowia Matki Polki.
Przegl Lek. 2006;63 Suppl 3:214-6.
Cyclosporin A (CsA) is an immunosuppressive agent used in children for the treatment of steroid-dependent idiopathic nephrotic syndrome (INS). Despite its benefitial effect on a course of the disease CsA may exert nephrotoxic effects because of its vasoconstrictive properties. CsA-dependent disorders of the peripheral flow (Raynaud phenomenon--RP) have been recently described. The aim of the study was to assess the effect of CsA on the peripheral circulation. The study group comprised 16 children (12 male, 4 female; mean age 9.8 +/- 4.5 years) treated with CsA for at least 6 months due to INS (mean treatment time 39 +/- 27 months). Thirteen age- and sex-matched individuals served as controls. Peripheral circulation disorders were evaluated by means of a cold stress test (both hands were held in lukewarm water (20 degrees C) for 1 minute and thereafter the changes in the hand temperature were recorded with thermographic camera (Inframetrics SC1000). RP assessment was performed according to the method described by Ammer and Ring. The temperature gradient of 4 degrees C or greater maintained between metacarpal and peripheral areas of a hand after 10 minutes was considered diagnostic for RP. According to these criteria RP was confirmed in only 3 patients from the study group and in 2 controls. However, the time of the temperature increase in the first 5 minutes after cooling was considerably shorter in the children with INS (0.26 +/- 0.26 degrees C/min vs 0.51 +/- 0.29 degrees C/min, p=0.02). No correlation between CsA serum concentration, CsA dose and impairment of the hand temperature increase was found. The study confirmed that in children suffering from INS treated with CsA peripheral blood flow disorders can be seen. It seems that impaired vessel reactivity may result from the vasoconstrictive effect of CsA.
环孢素A（CsA）是一种免疫抑制剂，用于儿童治疗依赖类固醇的特发性肾病综合征（INS）。尽管CsA对疾病进程有有益作用，但由于其血管收缩特性，可能会产生肾毒性作用。最近已描述了CsA依赖的外周血流紊乱（雷诺现象 - RP）。本研究的目的是评估CsA对外周循环的影响。研究组包括16名儿童（12名男性，4名女性；平均年龄9.8±4.5岁），因INS接受CsA治疗至少6个月（平均治疗时间39±27个月）。13名年龄和性别匹配的个体作为对照。通过冷应激试验评估外周循环紊乱（双手置于温水（20摄氏度）中1分钟，然后用热成像相机（Inframetrics SC1000）记录手部温度变化）。根据Ammer和Ring描述的方法进行RP评估。10分钟后掌骨和手部外周区域之间维持4摄氏度或更高的温度梯度被认为是RP的诊断标准。根据这些标准，研究组中只有3名患者和2名对照被确诊为RP。然而，INS患儿冷却后前5分钟温度升高的时间明显更短（0.26±0.26摄氏度/分钟对0.51±0.29摄氏度/分钟，p = 0.02）。未发现CsA血清浓度、CsA剂量与手部温度升高受损之间存在相关性。该研究证实，接受CsA治疗的INS患儿可出现外周血流紊乱。似乎血管反应性受损可能是由于CsA的血管收缩作用所致。
