Ferraris J R, Pasqualini T
Departamento de Pediatria, Hospital Italiano de Buenos Aires, Argentina.
J Rheumatol Suppl. 1993 Apr;37:43-6.
In children who have undergone successful renal transplantation, the failure of linear growth, a cushingoid appearance and obesity decrease self-esteem and hamper rehabilitation. Changes in kidney function, growth velocity, weight to height ratio and growth hormone (GH) secretion were studied before, and 2 years after, replacement of methylprednisone (6 +/- 0.3 mg/day; mean +/- SEM) by deflazacort (9.6 +/- 0.5 mg/day) 4 years after renal transplantation in 10 patients aged 9-16 years with stable renal function. Serum creatinine and creatinine clearance did not change significantly during deflazacort treatment. In 8 patients at Tanner stage I, growth velocity increased significantly during the 1st and 2nd year of deflazacort therapy (p < 0.01 and p < 0.005, respectively). Weight to height ratio decreased significantly during the 1st and 2nd year of deflazacort treatment (p < 0.005, p < 0.02, respectively) though in 3 patients, this returned to base levels after 2 years of deflazacort therapy. The mean spontaneous GH secretion increased significantly (p < 0.05). There was a correlation between growth velocity and spontaneous GH secretion during deflazacort therapy. The cushingoid appearance decreased in the majority of patients. Renal function remained stable.
在成功接受肾移植的儿童中，线性生长发育迟缓、库欣样面容和肥胖会降低自尊并阻碍康复。对10名9至16岁肾功能稳定的患者进行研究，在肾移植4年后，用去氟可特（9.6±0.5毫克/天）替代甲泼尼龙（6±0.3毫克/天；平均值±标准误）之前及之后2年，观察其肾功能、生长速度、体重身高比和生长激素（GH）分泌的变化。在去氟可特治疗期间，血清肌酐和肌酐清除率无显著变化。在8名处于坦纳I期的患者中，去氟可特治疗的第1年和第2年生长速度显著增加（分别为p<0.01和p<0.005）。去氟可特治疗的第1年和第2年体重身高比显著降低（分别为p<0.005，p<0.02），不过有3名患者在去氟可特治疗2年后恢复到基线水平。平均自发性GH分泌显著增加（p<0.05）。去氟可特治疗期间生长速度与自发性GH分泌之间存在相关性。大多数患者的库欣样面容有所减轻。肾功能保持稳定。
