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目的 探讨应用环磷酰胺联合疗法治疗儿童原发性肾病综合征复发的临床价值。方法 采用病例对照方法 ,将 93例肾病患儿随机分为环磷酰胺联合治疗组和单用激素治疗组。观察两组病例在相同时间内的复发次数、部分病例的肾脏组织病理形态变化及毒副反应。并对CTX疗效与病理类型的关系进行分析。结果 ①CTX治疗组复发次数明显低于单用激素组 (P <0 .0 0 1) ;②治疗组在使用CTX前后的自身对比中发现 ,CTX治疗后复发次数明显减少 (P <0 0 0 1) ;③在微小病变及系膜增殖性肾炎病例的重复肾活检发现 ,CTX有助于减轻病理形态学的改变 ;④CTX联合疗法能明显提高微小病变及系膜增殖性肾炎的临床基本治愈率 ;⑤在 44例CTX联合治疗中仅有 2例有轻微脱发和胃肠道反应。结论 CTX联合疗法能确实有效地防止和减少原发性肾病综合征患儿复发的机会 ,从而达到长期缓解直至治愈的目的。该疗法毒副反应小 ,安全、可靠、简便 ,可作为治疗小儿原发性肾病综合征复发的推荐治疗方案。
Objective To investigate the clinical value of cyclophosphamide combination therapy in relapse of children with primary nephrotic syndrome. Methods 93 cases of children with nephropathy were randomly divided into cyclophosphamide combined treatment group and hormone treatment group. The number of relapse of the two groups at the same time was observed. The pathological changes of renal tissues and the toxicities and side effects in some cases were observed. The relationship between CTX efficacy and pathological type was analyzed. Results ① The number of recurrence in CTX treatment group was significantly lower than that in single hormone therapy group (P <0.01). ② The self-comparison of CTX treatment group before and after CTX treatment showed that CTX treatment significantly reduced the number of recurrence (P0.01 ); ③ in patients with minimal change and mesangial proliferative glomerulonephritis repeated renal biopsy found that, CTX helps to reduce the pathological changes; ④CTX combination therapy can significantly improve the minimally pathological and mesorectal proliferative glomerulonephritis basic clinical cure rate; ⑤ In 44 cases of CTX combined treatment only 2 cases had slight hair loss and gastrointestinal reaction. Conclusion CTX combination therapy can effectively prevent and reduce the chance of relapse in children with primary nephrotic syndrome, so as to achieve long-term relief until cure. The therapy side effects of small, safe, reliable, simple, can be used as a treatment of relapse in children with primary nephrotic syndrome recommended treatment.