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【文摘发布】环孢霉素 A真的具有治疗原发性儿童
Sheashaa H, Mahmoud I, El-Basuony F, El-Husseini A, Hassan N, El-Baz M, Ahmed NS, Sobh M.
Nephrology unit, Urology & Nephrology Center, Mansoura, Egypt, drhattia@yahoo.com.
Int Urol Nephrol. 2007 Apr 20
BACKGROUND: Cyclosporine (CsA) was found to be efficient in decreasing proteinuria in both steroid-dependent and steroid-resistant nephrotic patients. We aimed to explore the potential long-term benefits and hazards of CsA and their predictors among a large group of nephrotic patients. METHODS: In this retrospective analysis, we included 197 pediatric patients with idiopathic nephrotic syndrome (INS) of whom 103 were steroid dependent and 94 steroid resistant. RESULTS: CsA induced complete remission in 132 (67%) and partial response in 13 (6.6%). Cyclosporine was received for a period of 22.16 +/- 12.21 months. Univariate analysis showed that the response to CsA was significantly better in steroid-dependent children, in minimal change disease (MCD), diffuse mesangial proliferative glomerulonephritis (DMP) and focal segmental glomerulosclerosis (FSGS) than in other pathological lesions and in those who had lower quantities of pretreatment proteinuria. Only the prior response to steroids and concomitant use of ketoconazole with CsA were valid predictors for better response to CsA with multivariate analysis. Discontinuation of the drug in 40 patients resulted in relapse in 26 patients while the remaining 14 patients maintained remission. Renal dysfunction developed in 18 patients of whom 12 recovered completely on drug discontinuation. Thirty-seven patients developed hypertension. Multivariate analysis showed that all side-effects were significantly more prevalent in CsA-resistant patients. CONCLUSION: CsA is effective and well tolerated in the long-term treatment of INS in children, however two thirds of cases showed relapse after CsA discontinuation. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Does cyclosporine achieve a real advantage for treatment of idiopathic steroid-resistant
激素抵抗的
diffuse mesangial proliferative glomerulonephritis
弥漫性系膜增殖性肾小球肾炎
who had lower quantities of pretreatment proteinuria
治疗前蛋白尿较低者。这里的pretreatment需联系上下文来理解，并非是预处理的意思。
of whom 12 recovered completely
其中12例曾经获得过完全缓解。
激素依赖性肾病的患儿显著优于激素非依赖性肾病的患儿
confusing wrote:
steroid-resistant
激素抵抗的
diffuse mesangial proliferative glomerulonephritis
弥漫性系膜增殖性肾小球肾炎
激素抵抗性和激素非依赖性是完全不同的两个概念，激素抵抗性肾小球肾炎是指使用足量激素后肾炎仍不能缓解。而激素非依赖性肾小球肾炎在肾内科不常使用，如果实在要这么说，也是指那些即使激素减量或撤除后并不反跳的肾炎。
系膜增殖性肾炎和系膜增生性肾炎是通用的。 那请教各位专家，国际上现在认为治疗儿童特发性肾病综合征的最佳方案是什么呢 儿童特发性肾病综合征的最佳方案仍然是标准激素疗法，请注意我选择的这篇文摘主要是针对激素依赖性和激素抵抗性肾病综合征而言的，也就是临床上常见的难治性肾病综合征。相对于成人来说，儿童难治性肾病综合征对环孢霉素 A的反应要好得多。但是，根据这篇文献和我们的经验，孢霉素 A停药后病情容易反复的问题并没有解决，所以，霉酚酸酯对无论是成人还是儿童难治性肾病综合征来说可能是一个不错的选择。 [标签:content1][标签:content2]阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-02-18 17:11
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