[环孢素A对儿童激素依赖型肾病综合征的影响]

[The effect of cyclosporine A in steroid-dependent nephrotic syndrome in children].

作者信息

Wasilewska Anna, Zoch-Zwierz Walentyna, Tomaszewska Barbara, Tenderenda Edyta

机构信息

I Klinika Chorób Dzieci AM w Białymstoku.

出版信息

Pol Merkur Lekarski. 2005 Feb;18(104):168-72.

PMID:17877123

Abstract

UNLABELLED

The aim of study was the analysis of cyclosporine A (CyA) treatment efficacy in children with steroid-dependent nephrotic syndrome (NS).

MATERIAL AND METHODS

The examined group consisted of 21 children (F--8, M--16) at the mean age 12.1 +/- 4.6 years with the relapses NS in the course of minimal change nephrotic syndrome (MCSN) in 9 (43%) and focal segmental glomerulosclerosis (FSGS) in 12 (57%) cases. All children were administrated CyA (Sandimun Neoral f. Novartis Pharma AG), together with prednisone (Encorton f. Polfa Pabianice) (0.2 - 0.5 mg/kg b.w./24 h) and ACE inhibitor (Enap f. Krka). The concentration of cyclospornine A in serum was measured by monoclonal antibody fluorescence polarization immunoassay. Serum concentration of creatinine, uric acid, albumin, cholesterol and creatinine clearance (Schwartz method) and proteinuria was analysed: A - before treatment, B--in 3rd day, C--in 3rd month, D--in 6th month, E--in 12th month of CyA treatment and F--after 3-6 months after finishing treatment. Blood pressure was measured by ABPM in examination A, D, E, and F.

RESULTS

During administration of CyA the urinary protein excretion decreased successively and in 12th month of treatment was 4.5 +/- 3.9 mg/kg bw/24 h. The serum creatinine concentration increased by 33.9%, and uric acid by 52.8% in comparison to the initial level. Mean systolic blood pressure (RRs) in ambulatory blood pressure monitoring (ABPM) during 24 hours was 120.5 +/- 9.2 mmHg before treatment and increased by about 6% after 12 months of treatment. Respectively diastolic blood pressure (RRr) was 66.7 +/- 4.3 mmHg and increased to 71.0 +/- 2.5 mmHg at the end of 12 h month. The nocturnal fall of RRs before treatment was 14.2 +/- 2.8%, and RRr 14.9 +/- 2.1%. During treatment nocturnal fall of both RRs and RRr decreased to 9.2 +/- 2.7% for RRs and 9.8 +/- 2.7% for RRr after 6 months of treatment. After 12 months of treatment and in remission the nocturnal fall of blood pressure was still below 10%.

CONCLUSIONS

CyA is an effective drug in children with relapses of steroid-dependent in the course of MCSN and FSGS. Side effects after CyA treatment, under the control of its concentration in serum and parameters of renal function are occasional and transient. Cyclosporine A disturbs the 24 hours rhythm of arterial blood pressure.

摘要

未标注

本研究的目的是分析环孢素A（CyA）治疗激素依赖型肾病综合征（NS）患儿的疗效。

材料与方法

研究组由21名儿童组成（女8名，男16名），平均年龄12.1±4.6岁，其中9例（43%）为微小病变型肾病综合征（MCSN）过程中的复发性NS，12例（57%）为局灶节段性肾小球硬化症（FSGS）。所有儿童均接受CyA（山德士新山地明，诺华制药公司）治疗，同时服用泼尼松（恩可通，波拉法比亚尼察公司）（0.2 - 0.5 mg/kg体重/24小时）和血管紧张素转换酶抑制剂（依那普利，克尔卡公司）。采用单克隆抗体荧光偏振免疫分析法测定血清中环孢素A的浓度。分析血清肌酐、尿酸、白蛋白、胆固醇浓度、肌酐清除率（施瓦茨法）和蛋白尿情况：A - 治疗前，B - 第3天，C - 第3个月，D - 第6个月，E - CyA治疗第12个月，F - 治疗结束后3 - 6个月。在检查A、D、E和F时采用动态血压监测（ABPM）测量血压。

结果

在服用CyA期间，尿蛋白排泄量逐渐减少，治疗第12个月时为4.5±3.9 mg/kg体重/24小时。与初始水平相比，血清肌酐浓度升高了33.9%，尿酸升高了52.8%。24小时动态血压监测（ABPM）中，治疗前平均收缩压（RRs）为120.5±9.2 mmHg，治疗12个月后升高了约6%。舒张压（RRr）分别为66.7±4.3 mmHg，在第12个月末升至71.0±2.5 mmHg。治疗前RRs的夜间下降幅度为14.2±2.8%，RRr为14.9±2.1%。治疗期间，RRs和RRr的夜间下降幅度在治疗6个月后分别降至9.2±2.7%（RRs）和9.8±2.7%（RRr）。治疗12个月且病情缓解后，血压的夜间下降幅度仍低于10%。