论文部分内容阅读
目的观察霉酚酸酯(MMF)联合中小剂量肾上腺皮质激素隔日治疗在儿童狼疮性肾炎(LN)的疗效,以探讨儿童LN的最佳治疗方案。方法回顾性分析1999—2004年在复旦大学附属儿科医院住院的LN患儿30例,男6例,女24例,处于病情的活动期,给予MMF联合中小剂量肾上腺皮质激素隔日治疗。MMF初始剂量为20-30mg/(kg.d)(总量<1.5g/d),病情好转后每3-6个月减量1次,至0.25g/d维持。甲基泼尼松龙冲击治疗15-30mg/(kg.d)(总量≤1.0g/d),初始剂量1.0-1.5mg/(kg.d)(总量≤60mg/d)。结果(1)30例患儿MMF治疗时间不少于6个月,为(28.6±15.1)个月,在治疗过程中未见明显副反应;(2)在肾活检的24例中,狼疮性肾炎Ⅱ型者8例在加用MMF治疗的3-6个月获得缓解;狼疮性肾炎Ⅳ型者16例,12例在治疗的3-12(6.0±1.3)个月获得缓解,1例患儿部分缓解,3例患儿经过至少6个月的足量MMF治疗无效。(3)在治疗过程中有7例患儿在减量或停药后出现疾病的复发或部分复发。(4)随访终点获得缓解的27例患儿,治疗前后身高增长无明显抑制。结论MMF联合中小剂量的泼尼松龙能有效地治疗儿童系统性红斑狼疮,较长时间应用无明显副反应。患儿可保持相对正常的生长发育。
Objective To observe the curative effect of mycophenolate mofetil (MMF) combined with mid-small dose of corticosteroid on the second day in children with lupus nephritis (LN), so as to explore the best treatment for children with LN. Methods A retrospective analysis of 30 children with LN admitted to the Pediatric Hospital affiliated to Fudan University from 1999 to 2004 was performed in 6 active males and 24 females with active phase of disease and MMF combined with mid-small dose of adrenal corticosteroids. MMF initial dose of 20-30mg / (kg.d) (total <1.5g / d), the condition improved after every 3 to 6 months reduction 1, to 0.25g / d maintained. Methylprednisolone impact treatment 15-30mg / (kg.d) (total ≤ 1.0g / d), the initial dose of 1.0-1.5mg / (kg.d) (total ≤ 60mg / d). Results (1) 30 cases of MMF treatment time of not less than 6 months, (28.6 ± 15.1) months, no significant side effects in the course of treatment; (2) in the renal biopsy in 24 cases, lupus Nephritis Ⅱ type in 8 cases with MMF treatment of 3-6 months to obtain relief; lupus nephritis Ⅳ type in 16 cases, 12 cases in the treatment of 3-12 (6.0 ± 1.3) months to obtain relief, 1 patient Children were partially relieved and 3 children were ineffective at adequate MMF after at least 6 months. (3) During the course of treatment, 7 patients experienced recurrence or partial recurrence of the disease after reduction or withdrawal. (4) 27 children who were relieved at the end of follow-up had no significant inhibition on height growth before and after treatment. Conclusion MMF combined with low-dose prednisolone can effectively treat children with systemic lupus erythematosus, long-term use without obvious side effects. Children can maintain relatively normal growth and development.