Servicio de Nefrología Pediátrica, Hospital Italiano, Buenos Aires, Argentina.
Pediatr Nephrol. 2010 Apr;25(4):753-62. doi: 10.1007/s00467-010-1458-5. Epub 2010 Feb 12.
Allograft function and metabolic effects of four treatment regimens, namely, methylprednisone (MP) standard dose (MP-STD), deflazacort (DFZ), MP-late steroid withdrawal (MP-LSW), and MP-very low dose (MP-VLD), were evaluated in prepubertal patients. MP was decreased by month 4 post-transplantation to 0.2 mg/kg/day in MP-STD and DFZ patients and to <0.1 mg/kg/day in MP-LSW and MP-VLD patients. Starting in month 16 post-transplant, MP was switched to DFZ in the DFZ group and totally withdrawn in the MP-LSW group. Creatinine clearance diminished in the MP-STD and MP-LSW groups from 77 +/- 6 to 63 +/- 6 ml/min/1.73 m(2)and from 103 +/- 5 to 78 +/- 3 ml/min/1.73 m(2), respectively (p < 0.01 and p < 0.001, respectively). Height increased >0.5 SDS only in the MP-LSW and MP-VLD groups. The body mass index and fat body mass for height-age increased only in the MP-STD patients (p < 0.05 and p < 0.01, respectively). Fat body mass decreased in the DFZ group (p < 0.05), total cholesterol and LDL-cholesterol increased in the MP-STD group, while LDL-cholesterol and total cholesterol/HDL-cholesterol ratio decreased in the DFZ group (p < 0.01). Lumbar spine bone mineral density (BMD) for height-age showed an increase in the MP-LSW and MP-VLD groups (p < 0.01). Our data suggest that MP-LSW and MP-VLD strategies improve linear growth, BMD, the peripheral distribution of fat, and preservation of the bone-muscle unit and maintain the normal lipid profile. The MP-LSW patients had a concerning rate of acute rejections and graft function deterioration in prepubertal patients.
在青春期前患者中，评估了四种治疗方案（即甲泼尼龙（MP）标准剂量（MP-STD）、地夫可特（DFZ）、MP 晚期撤药（MP-LSW）和 MP 超低剂量（MP-VLD））的同种异体移植物功能和代谢效应。在移植后第 4 个月，MP-STD 和 DFZ 患者的 MP 减少至 0.2mg/kg/天，MP-LSW 和 MP-VLD 患者减少至 <0.1mg/kg/天。在移植后第 16 个月，DFZ 组开始将 MP 转换为 DFZ，MP-LSW 组完全撤药。MP-STD 和 MP-LSW 组的肌酐清除率从 77±6 降至 63±6ml/min/1.73m2和从 103±5 降至 78±3ml/min/1.73m2（分别为 p<0.01 和 p<0.001）。仅在 MP-LSW 和 MP-VLD 组中身高增加>0.5SDS。仅在 MP-STD 患者中体重指数和身高年龄的体脂肪量增加（分别为 p<0.05 和 p<0.01）。DFZ 组的体脂肪量减少（p<0.05），MP-STD 组的总胆固醇和 LDL 胆固醇增加，而 DFZ 组的 LDL 胆固醇和总胆固醇/HDL 胆固醇比值降低（p<0.01）。身高年龄的腰椎骨密度（BMD）在 MP-LSW 和 MP-VLD 组中增加（p<0.01）。我们的数据表明，MP-LSW 和 MP-VLD 策略可改善线性生长、BMD、脂肪的外周分布以及骨骼肌肉单位的保留，并维持正常的血脂谱。在青春期前患者中，MP-LSW 患者出现急性排斥反应和移植物功能恶化的发生率令人担忧。
