| Objective : Henoch-Schonlein purpura(HSP)is a commonsystemic allergic vasculitis with violations of capillaries in children.clinical manifestations include skin purpura,arthritis,gastrointestinal lesions and kidney damage and so on Research have reported that all of the HSP children has different degrees of kidney problem as the renal biopsy prevail.So doctors need to observe the clinical symptoms,use renal biopsy to clarfy the renal pathological changes and related treatment should under the guidance of kidney pathology.Through the positive and correct treatment,most of the HSPN children have a good prognosis,but nearly 1.0% to 15.7% of children may have progressive renal damage,about 3% of the HSPN will progress to the end of the kidney and l need alternative therapy.Tacrolimus(TAC)is a calcium phosphate inhibitor which is isolated from the fermentation broth of soil fungi TAC is a kind of macrolide antibiotics,it is used in organ transplantation after the immune rejection as the first-line medicationin recent years TAC play an immunosuppressive effect through inhibiting lymphocyte proliferation,increasing interleukin 2(IL-2)m RNA and transforming growth factor(TGF-?)expression.So far,there is not a unified treatment program for treating HSPN.KDIGO clinical practice guide suggest that treatment of HSPN is similar to Ig A nephropathy in 2012.In the research,tacrolimus is used in the treatment of severe purpura nephritis to observe its efficacy and safety.However,plasma concentration of TAC need to monitored because its larger pharmacokinetic and stenotic drug concentration.To achieve the greatest therapeutic effect in the case of the smallest side effects is a better way to give individualized dosing regimen.So,to observe the relationship between therapeutic effect and TAC plasma concentration is needed.Methods: Children with HSPN who is hospitalized from January 2015 to January 2016 were collected.Inclusive criteria as: urine protein was still a large amount of proteinuria(?50mg/kg/24h)after 4 weeks of treatment with sufficient hormones(2mg/kg);or the urinary protein without negative for 8 weeks(?0.5g/24h).In the children with pathological type of HSPN(?b type),methylprednisolone sodium succinate(15-20mg/kg)were given 3 times followed with therapeutic hormone orally(2mg/g).Efficacy evaluation is divided into: complete remission: urinary protein quantitative?0.12g/24h;partial remission: urinary protein>0.12g/24 h and <50mg/kg/24h;invalid: urine protein?50mg/kg/24 h.Children's blood,urine,urine protein quantitative,liver and kidney function,fasting blood glucose,urine NAG enzyme,tacrolimus plasma concentration were regular monitored for12 months.Results: A total of 28 patients with HSPN were enrolled in this study.The mean age was(8.28 ± 1.78)years and the mean follow-up time was(16 ± 4.24)months.The mean urinary protein was(2.54 ± 1.84)g/24 h before tacrolimus treatment.Results showed that: 1.two weeks of tacrolimus treatment: the partial remission rate was 71.43% and complete remission rate was 7.14%.2.four weeks of tacrolimus treatment: the partial remission rate was 71.43% and complete remission rate was 21.42%.3.Three months of tacrolimus treatment: the partial remission rate was 50% and complete remission rate was 42.86%.4.Six months of tacrolimus treatment: the partial remission rate was 28.57% and complete remission rate was 71.43%.5.Twelvemonths of tacrolimus treatment: the partial remission rate was 96.43% and complete remission rate was 3.57%,with 18 cases of drug withdraw l and 3 cases relapsed.Two of these children were ineffective at the end of three months treatment,complete remission was achieved combined with LEF and hormone and TAC treatment at the end of 12 months.The levels of urinary protein were significantly decreased after the two weeks,four weeks and three months treatment,with statistically significant difference(P<0.05).But,there was no significant difference in serum creatinine,liver function,fasting blood glucose and urinary Nagase between the patients before and after treatment(P> 0.05).Recurrence: During the follow-up time from 12 to 24 months,3 children showed recurrence in the total of 18 withdrawal cases.Drug related adverse events included 1 case of hand trembling(3.57%),2 cases of increased serum creatinine and corrected creatinine clearance rate decreased(7.14%).Conclusions: Tacrolimus combined with glucocorticoid is effective for treatment of severe purpura nephritis,with a effective rate of 92.86% for 3 months treatment which showed a lower relapse rate and no significant side effects,is an effective method of treatment of purpura nephritis. |
PDF Full Text Request