Cochat P, David L, Parchoux B, Freycon M T, Larbre F
Unité de Néphrologie pédiatrique, hôpital Edouard-Herriot, Lyon, France.
Pediatrie. 1987;42(7):519-26.
Good clinical results are well known with the use of immunosuppressive therapy in children with idiopathic nephrotic syndrome; more recently, biological data have enhanced immunological anomalies, concerning mainly T helper lymphocytes. The need for steroids may decrease when relapsing nephrotic syndrome is associated with steroid intoxication and is absent when corticoresistance occurs. In these cases, the use of immunosuppressive agents is justified, but limited by side effects and toxicity. In patients treated with alkylating agents and now cyclosporine, good responses are often seen in frequently relapsing children whereas the course of steroid-resistant nephrotic syndrome is not significantly modified. However, the definite appreciation of such therapeutic results has to be further precised by both histological data and multicentric studies concerning new protocols.
免疫抑制疗法用于治疗儿童特发性肾病综合征已取得了良好的临床效果；最近，生物学数据进一步揭示了主要涉及辅助性T淋巴细胞的免疫异常情况。当复发性肾病综合征伴有类固醇中毒时，对类固醇的需求可能会减少，而当出现皮质激素抵抗时则无需使用类固醇。在这些情况下，使用免疫抑制剂是合理的，但会受到副作用和毒性的限制。在用烷化剂以及现在的环孢素治疗的患者中，频繁复发的儿童常常会出现良好的反应，而类固醇抵抗性肾病综合征的病程则没有明显改善。然而，必须通过组织学数据以及有关新方案的多中心研究来进一步明确对此类治疗结果的肯定评价。
