| Objective To observe the efficacy and safety of multi-target immunosuppressive therapy in treatment of children with steroid-resistant nephritic syndrome(SRNS).Methods A total of 48 children with SRNS were enrolled from september 2013 to october 2015 in this multicenter prospective study.Based on the same comprehensive treatment,the children were randomly divided into two groups: 1observation group: boys 20 cases,grils 5 cases,the average age was(5.84±4.18)years.In this group, 21 cases of them were taken renal biopsy:focal segmental glomerulosclerosis(FSGS) 3 cases, mesangial proliferative glomerulonephritis(Ms PGN) 5 cases,membrano-proliferative glomerulonephritis(MPGN) 2 cases,membranous nephropathy(MN) 2 cases, minimal change disease(MCD) 9 cases,were orally given Cs A [3~4mg/(kg·d)] and MMF [20mg/(kg·d)] multi-target immunosuppressive therapy; 2control group:boys 18 cases,grils 5cases, the average age was(5.30±3.14)years. In this group, 20 cases of them were taken renal biopsy:FSGS 2 cases, Ms PGN 6 cases,MPGN 2 cases,MN 2 cases, MCD8 cases,were orally given Cs A [4~6mg/(kg·d)].The effect estimated by urine protein to creatinine ratios or urine protein(routine urine test)and plasma albumin.The total remission rate included complete remission and partial remission.The side effect were closely observed.The plasma concentrations of Cs A,urine protein to creatinine ratios,liver and kidney function,blood routine and urine β2-microglobulin were respectively compared among two groups after 2 weeks,1 month,3months and 6 months of treatment.Results1.The average plasma concentrations of Cs A in the observation group was(88.86±16.94) μg/L,and the control group was(152.96±19.20) μg/L(P<0.001).2.The urine protein to creatinine ratios(2.29±0.27、2.22±0.26) mg/mg and serum albumin(15.54±6.42、15.53±4.62) g/l in the observation group and control group before treatment was no differences(P>0.05).3.The urine protein to creatinine ratios in the observation group after 1 month,3 months treatment(0.92±0.85,0.43±0.73) mg/kg was lower than prior treatment,and was lower than the control group in the same time(1.61±0.77,0.93±0.93) mg/kg,it was significantly different(P<0.05). The urine protein to creatinine ratios in the observation group after 2weeks, 6 months treatment(1.75±0.67,0.51±0.71) mg/kg was lower than prior treatment,and was lower than the control group in the same time(1.94±0.50,0.58±0.75) mg/kg,but no differences(P>0.05).4. The serum albumin in the observation group after 1 month,3 months treatment(24.54±6.23, 28.85±7.97) g/l was higher than prior treatment,and was higher than the control group in the same time(20.88±5.60,23.97±7.52) g/l, it was significantly different(P<0.05).The serum albumin in the observation group after 2 weeks, 6 momths treatment(19.79±7.10,31.43±7.30) g/l was higher than prior treatment,and was higher than the control group in the same time(17.73±5.18,29.53±7.14) g/l, but no differences(P>0.05).5. The urine β2-microglobulin in this two groups was declined after treatment,but no differences between this two groups(P>0.05).6.The overall remission rate of the observation group was 88%,and in the control group was 87%. The remission rate of the observation group after 2 weeks,1 month treatment was better than the control group, it was significantly different(P<0.05);The remission rate of the observation group after 3 months,6 months treatment was better than control group,but it was no differences(P>0.05).7.The main side effect during therapy was infection,gastrointestinal reaction,crinosity, hypertension and leukocyte decrease.The side effect of the observation group was less than the control group(P<0.05).Conclusions The multi-targe immunosuppressive therapy in children with SRNS by Cs A and MMF can obvious improve urine protein and plasma albumin, offered early remission and can keep long-term remission as only by Cs A,and with mide side effect. |
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