左旋咪唑在早期与晚期激素反应性肾病综合征中的短期和长期结局：单中心经验

Short and long-term outcome of levamisole in early versus late steroid responsive nephrotic syndrome: A single centre experience.

作者信息

Kashif Saima, Moorani Khemchand N

机构信息

Saima Kashif, MBBS, FCPS (Pediatrics), FCPS Pediatr Nephrol. Assistant Professor, Department of Pediatric Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi. 197/9, Rafiqui Shaheed Road, Karachi-75530, Pakistan.

Khemchand N Moorani, MBBS, MCPS, FCPS, IPNA Pediatr Nephrol fellowship Professor, Department of Pediatric Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi. 197/9, Rafiqui Shaheed Road, Karachi-75530, Pakistan.

出版信息

Pak J Med Sci. 2025 Jan;41(1):64-70. doi: 10.12669/pjms.41.1.10184.

DOI:10.12669/pjms.41.1.10184

PMID:39867780

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11755277/

Abstract

OBJECTIVES

To determine the effectiveness of Levamisole (Leva) in maintaining short-term and long-term remission in early steroid responders (ESRs) and late steroid responders (LSRs).

METHODS

This retrospective study on 106 cohorts, aged 2-14 years with frequent-relapsing (FR) and steroid-dependent nephrotic syndrome (SDNS) who received Leva over 10-years (2012-2023), was carried out at tertiary care centre, Karachi from January-August 2023. Patients were categorized based on steroid response during first episode of NS as ESRs if complete remission (CR) was achieved within two weeks of daily steroid and LSRs if CR achieved between two-four weeks. Leva was administered after inducing remission with daily steroid after labelling as FRNS and SDNS. Low-dose steroid was continued during Leva-therapy. Short-term outcome was assessed at completion of Leva and long-term outcome in terms of CR, relapse frequency, alternative immunosuppressive agents (ISAs) use and compliance was assessed at six, 12 and 36-months' follow-up while off levamisole therapy.

RESULTS

Leva was used in 106 patients (male 67%) for 20.4±8months during the study period. The mean age at Leva-initiation was 6.3±3 years. Eighty-three were FRNS and 23 SDNS. ESRs were 64 and 42 were LSRs. Overall, Leva was effective in maintaining short-term CR (73%) at end of Leva and it was effective in both ESRs (75%) and LSRs (69%, p=0.51) as well as in FRNS (72%) and SDNS (74%), P=0.08). Post-Leva follow-up duration was 36±31 months. Long-term Leva was effective in both ESRs and LSRs (p=0.51). Complete remission in 22,17 and 26%; infrequent relapses in 50,40 and 5% and alternate ISAs use in 24,39 and 55% at six,12 and 36 months follow-up respectively.

CONCLUSION

Levamisole was effective in maintaining short-term and long-term remission in early and late initial steroid responsive nephrotic syndrome.

摘要

目的

确定左旋咪唑（Leva）在维持早期激素反应者（ESR）和晚期激素反应者（LSR）短期和长期缓解方面的有效性。

方法

这项回顾性研究于2023年1月至8月在卡拉奇的三级医疗中心开展，研究对象为106名年龄在2至14岁、患有频繁复发（FR）和激素依赖型肾病综合征（SDNS）且在10年期间（2012 - 2023年）接受Leva治疗的队列。根据肾病综合征首次发作时的激素反应情况对患者进行分类，如果在每日使用激素两周内实现完全缓解（CR）则为ESR，如果在两周至四周内实现CR则为LSR。在被标记为FRNS和SDNS并经每日激素诱导缓解后给予Leva。在Leva治疗期间继续使用低剂量激素。在Leva治疗结束时评估短期结局，在停用左旋咪唑治疗后的6个月、12个月和36个月随访时评估长期结局，包括CR、复发频率、替代免疫抑制剂（ISA）的使用情况和依从性。

结果

在研究期间，106名患者（67%为男性）使用Leva的时间为20.4±8个月。开始使用Leva时的平均年龄为6.3±3岁。83例为FRNS，23例为SDNS。ESR有64例，LSR有42例。总体而言，Leva在治疗结束时有效维持短期CR（73%），在ESR（75%）和LSR（69%，p = 0.51）以及FRNS（72%）和SDNS（74%）中均有效，P = 0.08。Leva治疗后的随访时间为36±31个月。长期来看，Leva在ESR和LSR中均有效（p = 0.51）。在6个月、12个月和36个月随访时，完全缓解率分别为22%、17%和26%；复发不频繁率分别为50%、40%和5%；替代ISA使用率分别为24%、39%和55%。