Kemper M J, Amon O, Timmermann K, Altrogge H, Müller-Wiefel D E
Universitäts-Kinderklinik, Hamburg.
Dtsch Med Wochenschr. 1998 Feb 27;123(9):239-43. doi: 10.1055/s-2007-1023943.
The treatment of frequently relapsing steroid-sensitive nephrotic syndrome in children with established immunosuppressive drugs (steroids, cyclophosphamide, cyclosporin A) sometimes presents problems because of the expected incidence of side effects. Stimulation of the immune system with the anthelminthic drug levamisole in this disease has been documented. Aim of this study was to assess in a prospective but uncontrolled series of observations its value and side effects.
25 patients (15 boys, ten girls; median age 10 [3.5-22] years) were given levamisole, 2 mg/kg/48 h. Before this treatment was started eight of the children/adolescents (32%) had frequent relapses and 17 (68%) had become steroid-dependent. Treatment was started during steroid-induced remission and continued for 3-24 (median 6) month, while steroids were discontinued after four weeks.
Relapse frequency per patient month was reduced from a mean of 0.5 (0.33-0.83) before to 0.31 (0-0.67) during levamisole administration (P < 0.001). In 12 patients (48%) no or considerably fewer relapses were observed. Patients with exclusively frequent relapses responded to levamisole better than those with steroid dependence (7/8 [87.5%] vs. 5/18 [27.7%], P = 0.01). Side effects were reversible leukopenia in two patients and nonspecific skin rash as well as epigastric pain in one patient.
Levamisole is an efficacious addition or alternative, with a low incidence of side effects, in the treatment of frequently relapsing nephrotic syndrome, particularly so in yet steroid-dependent patients.
在儿童频繁复发的激素敏感型肾病综合征治疗中，使用已有的免疫抑制药物（类固醇、环磷酰胺、环孢素A）时，由于预期的副作用发生率，有时会出现问题。在这种疾病中，使用驱虫药左旋咪唑刺激免疫系统已有文献记载。本研究的目的是在一个前瞻性但未设对照的观察系列中评估其价值和副作用。
25例患者（15例男孩，10例女孩；中位年龄10[3.5 - 22]岁）接受左旋咪唑治疗，剂量为2mg/kg/48小时。在开始该治疗前，8名儿童/青少年（32%）频繁复发，17名（68%）已对类固醇产生依赖。治疗在类固醇诱导缓解期开始，持续3 - 24（中位6）个月，而类固醇在4周后停用。
每位患者每月的复发频率从左旋咪唑给药前的平均0.5（0.33 - 0.83）降至给药期间的0.31（0 - 0.67）（P < 0.001）。12例患者（48%）未观察到复发或复发明显减少。单纯频繁复发的患者对左旋咪唑的反应比对类固醇依赖的患者更好（7/8[87.5%]对5/18[27.7%]，P = 0.01）。副作用包括2例患者出现可逆性白细胞减少，1例患者出现非特异性皮疹和上腹部疼痛。
左旋咪唑是治疗频繁复发的肾病综合征的一种有效补充或替代药物，副作用发生率低，尤其对于仍依赖类固醇的患者。
