Goumenos Dimitrios S, Kalliakmani Pantelitsa, Savvidaki Eirini, Vlachojannis John G
Internal Medicine-Nephrology, University Hospital of Patras, 26500 Patras, Greece.
BMC Res Notes. 2009 Jul 22;2:144. doi: 10.1186/1756-0500-2-144.
Adult minimal changes disease (MCD) is usually treated by high corticosteroids dose in order to achieve remission of nephrotic syndrome. In this study, the administration of high steroid dose (prednisolone 1 mg/kg BW/day) is compared with the combination of lower prednisolone dose (0.3 mg/kg BW/day) and cyclosporine A (CsA) (2-3 mg/kg BW/day) in a small number of patients.
Eighteen patients were allocated to either prednisolone monotherapy or prednisolone and CsA combination, according to the risk of developing steroid side-effects. Complete remission of the nephrotic syndrome was observed in all patients treated by steroids or combination of steroids and CsA. Complete remission occurred in 67%, 89% and 100% of patients after 4, 8 and 12 weeks of treatment. Relapses occurred in 50% of patients from both groups, treated with the combination of low prednisolone dose and CsA and followed by sustained remission. Corticosteroidal side effects were observed only in high prednisolone dose (accumulated dose: 92.7 +/- 22 mg/kg/BW vs. 58.5 +/- 21 mg/kg/BW, p = 0.004).
Treatment of adult MCD with low prednisolone dose and CsA seems to be equally effective with high prednisolone dose to induce remission of nephrotic syndrome. It is also effective as maintenance therapy for prevention of relapses and less frequently followed by corticosteroidal side effects.
成人微小病变病（MCD）通常采用高剂量皮质类固醇进行治疗，以实现肾病综合征的缓解。在本研究中，对少数患者比较了高剂量类固醇（泼尼松龙1mg/kg体重/天）与低剂量泼尼松龙（0.3mg/kg体重/天）和环孢素A（CsA）（2 - 3mg/kg体重/天）联合使用的效果。
根据发生类固醇副作用的风险，将18名患者分为泼尼松龙单药治疗组或泼尼松龙与CsA联合治疗组。在接受类固醇或类固醇与CsA联合治疗的所有患者中均观察到肾病综合征完全缓解。治疗4、8和12周后，完全缓解的患者分别占67%、89%和100%。两组中接受低剂量泼尼松龙与CsA联合治疗并随后持续缓解的患者，50%出现复发。仅在高剂量泼尼松龙组观察到皮质类固醇副作用（累积剂量：92.7±22mg/kg体重 vs. 58.5±21mg/kg体重，p = 0.004）。
低剂量泼尼松龙与CsA治疗成人MCD在诱导肾病综合征缓解方面似乎与高剂量泼尼松龙同样有效。作为预防复发的维持治疗也有效，且较少出现皮质类固醇副作用。
