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目的比较他克莫司(FK506)与吗替麦考酚酯(MMF)分别联合激素治疗儿童激素依赖肾病综合征/频复发肾病综合征(SDNS/FRNS)的临床疗效。方法回顾分析2009年1月—2015年7月浙江大学医学院附属儿童医院收住的49例SDNS/FRNS患儿,FK506组有21例,28例MMF组患儿根据霉酚酸曲线下面积(MPA-AUC)分为低浓度组[MPA-AUC<30μg/(ml·h)]和高浓度组[MPA-AUC≥30μg/(ml·h)],比较各组治疗效果。结果 (1)激素用量:随访半年,各组激素用量均明显减少,同初始激素用量比较有统计学差异,P<0.01;其中MMF高浓度组激素用量最少,同低浓度组相比,有统计学差异,P<0.05。随访1年组间激素用量无明显差异,P>0.05。(2)复发次数:随访半年,各组复发次数明显减少,除低浓度组外,其他各组同治疗前比较均有统计学差异,P<0.05;其中MMF低浓度组平均反复次数最多,同高浓度组相比有统计学差异,P<0.05。随访1年组间平均反复次数无统计学差异,P>0.05。结论 FK506与MMF联合激素治疗SDNS/FRNS患儿临床疗效差异无统计学意义;随访半年时MMF高浓度组治疗效果最佳,MMF低浓度组治疗效果最差。MMF低浓度组患儿如半年未出现频反复,完成1年随访,与其他组临床效果无差异。
Objective To compare the clinical efficacy of tacrolimus (FK506) and mycophenolate mofetil (MMF) in steroid-dependent nephrotic syndrome / recurrent nephrotic syndrome (SDNS / FRNS). Methods A retrospective analysis was conducted among 49 children with SDNS / FRNS admitted to Children’s Hospital of Zhejiang University School of Medicine between January 2009 and July 2015. There were 21 cases in FK506 group and 28 cases in MMF group. According to the area under curve of mycophenolate mofetil MPA-AUC) were divided into low-concentration group [MPA-AUC <30μg / (ml · h)] and high concentration group [MPA-AUC≥30μg / (ml · h)]. Results (1) The amount of hormones: Followed up for six months, the amount of hormones in each group were significantly reduced, with the initial hormone dosage was statistically significant, P <0.01; of which the MMF high concentration group, the least amount of hormones, with the low concentration group, Learning difference, P <0.05. There was no significant difference in the amount of hormones between the 1-year follow-up groups, P> 0.05. (2) The frequency of recurrence: The follow-up of six months, the number of relapse in each group decreased significantly, except for the low concentration group, the other groups were statistically different compared with before treatment, P <0.05; the MMF low concentration group, the average number of repetitions, There was significant difference between high concentration group, P <0.05. No significant difference was found in the average number of repeated visits between the two groups (P> 0.05). Conclusion There was no significant difference in clinical efficacy between FK506 and MMF combined with hormone therapy in children with SDNS / FRNS. MMF high-concentration group had the best treatment effect at half a year follow-up, and MMF low concentration group had the worst treatment effect. MMF low concentration group, such as six months without recurrence of frequency, complete 1-year follow-up, no difference between the clinical efficacy of other groups.