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目的 :为了探讨儿童原发性肾病综合征病理类型与激素疗效之间的关系。 方法 :对 16年来经肾活检明确病理类型的 410例原发性肾病综合征患儿应用泼尼松治疗的疗效分析 ,初始剂量为 2 m g/( kg· d) ,最大量不超过6 0 mg/d,共用 8周 ,部分迟发敏感的患儿再延长 2周 ;如完全缓解则逐渐减量 ;如部分缓解或不缓解 ,则逐渐减量并加用免疫抑制剂。 结果 :410例中 ,微小病变 ( MCNS) 71例 ,系膜增生 ( Ms PGN) 2 5 5例 ,膜增殖 ( MPGN) 2 9例 ,膜性肾病 ( MN) 2 8例 ,局灶节段性肾小球硬化症 ( FSGS) 2 7例 ,对激素治疗完全效应者分别为 91.5 %、79.2 %、2 4.1%、2 1.4%和 2 2 .2 % ,后续治疗仍可取得部分疗效。 结论 :1对儿童原发性肾病综合征必须尽快明确病理类型 ;2病理类型为 MCNS和 Ms PGN者 ,宜正规、足量地使用泼尼松 ,以达到较好的治疗目的 ;3病理类型为 MN、FSGS和 MPGN者 ,亦宜足量应用 ,即使在足量应用期间疗效不高 ,在后续治疗中仍可取得一定的效果
Objective: To investigate the relationship between the pathological type of primary nephrotic syndrome and the effect of hormones in children. Methods: The efficacy of prednisone in 410 children with primary nephrotic syndrome who had been confirmed by renal biopsy in 16 years was analyzed. The initial dose was 2 mg / (kg · d) and the maximum dose was less than 60 mg / d, shared for 8 weeks, some patients with late-sensitive and then extended for 2 weeks; if complete remission then tapering; such as partial remission or non-remission, the gradual reduction and the addition of immunosuppressive agents. Results: Among the 410 cases, there were 71 cases of MCNS, 255 cases of mesangial proliferation (Ms PGN), 29 cases of MPGN, 28 cases of membranous nephropathy (MN), focal segmental 27 cases of glomerulosclerosis (FSGS) were 91.5%, 79.2%, 21.4% and 22.2%, respectively. The follow-up treatment could still achieve partial effect. Conclusion: 1 pairs of children with primary nephrotic syndrome pathology must be clear as soon as possible; 2 pathological types of MCNS and Ms PGN who should be regular and adequate use of prednisone in order to achieve better therapeutic purposes; 3 pathological types MN, FSGS and MPGN should also be sufficient, even in the full effect of the application is not high, follow-up treatment can still achieve some results