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阿奇霉素治疗儿童原发性肾病综合征反复或复发效果探讨

张碧丽1,王文红1,张瑄1,1,范树颖2,刘竹枫1,刘喆1,吴瑕1   

  1. 1. 天津市儿童医院
    2. 儿童医院肾内科
  • 收稿日期:2012-06-04 修回日期:2012-10-25 出版日期:2013-05-15 发布日期:2013-05-15
  • 通讯作者: 张碧丽

Effects of Azithromycin on Recurrence or Relapse of PrimaryNephrotic Syndrome in Children

  • Received:2012-06-04 Revised:2012-10-25 Published:2013-05-15 Online:2013-05-15

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摘要：

目的? 探讨儿童原发性肾病综合征（PNS）在糖皮质激素（GC）减量过程中出现反复和（或）复发现象时阿奇霉素的干预作用。方法? 179例PNS反复或复发的患儿随机分为治疗组和对照组，治疗组予口服阿奇霉素，剂量10 mg/(kg·d)，3 d为1个疗程；对照组予非大环内酯类抗生素治疗。对其年龄、性别、体质量、反复或复发情况、总病程、GC的每日用量及累积应用总时间、24 h尿蛋白定量（24 h-Upro）、血总蛋白（Tp）、白蛋白（Alb）、胆固醇（Tcho）、尿素氮（Bun）、肌酐（Scr）、免疫球蛋白（IgA、IgG、IgM、IgE）、补体（C3、C4）及血支原体IgM抗体阳性比例等临床特征、血尿生化指标进行单因素分析及多因素Logistic回归分析。结果? 治疗组与对照组患儿以及治疗组中阿奇霉素有效患儿与无效患儿一般资料及血尿监测指标比较差异均无统计学意义。治疗组有效率（75.28%）高于对照组（34.44%），差异有统计学意义。治疗组中阿奇霉素有效与无效患儿的就诊前尿蛋白定性程度和就诊前尿蛋白持续天数差异均有统计学意义。Logistic回归分析显示，治疗前尿蛋白持续时间越短阿奇霉素干预有效率越高。结论? 在PNS患儿出现反复或复发现象的早期予以阿奇霉素干预治疗可得到较好的疗效，阿奇霉素有可能作为GC的助减剂为反复或复发的PNS患儿提供一种新的治疗选择。

关键词: 肾病综合征, 糖皮质激素类, 复发, 儿童, 阿奇霉素

Abstract: Abstract Objective   To explore the intervention effect of Azithromycin in recurrence and(or) relapse on the glucocorticoid reduction course of primary nephrotic syndrome in children. Methods   One hundred and seventy-nine patients who had a relapse/ recurrence of nephrotic syndrome were randomly divided into treatment group and control group. Treatment group patients were treated with azithromycin 10 mg/kg each day, 3 days for a course, and the patients of control group were given non-macrolide antibiotics, oral or intravenous. The clinical and laboratory data [age, gender, weight, repeated/recurrence condition, the time of NS, the daily dosage of GC, the total time of GC cumulative application, 24 h urine protein quantitative (24 h - Upro), blood total protein (Tp), albumin (Alb), cholesterol (Tcho), urea nitrogen (Bun), serum creatinine (Scr), immune globulin (IgA, IgG, IgM, IgE), complement (C3, C4), blood mycoplasma IgM antibody positive ratio, etc]were analyzed by single and multiple regression analysis. Results  No significant difference was found in clinical and laboratory data between treatment group and control group and between Azithromycin effective group and Azithromycin ineffective group. There were significant differences on the efficient of treatment group (75.28%) and control group (34.44%). Urinary protein qualitative degree and the length days of urine protein before the treatment was different between the Azithromycin effective group and Azithromycin ineffective group. The non-conditional logistic regression analysis of treatment group revealed that the higher efficiency appear in the cases with the shorter duration days of Urinary protein before treatment. Conclusion  Azithromycin is effective in the early stage of PNS relapse/ recurrence children. Azithromycin maybe used as a steroid-sparing medicine. Azithromycin will provide a new treatment option to the PNS children with relapse or recurrence.

Key words: nephrotic syndrome, glucocorticoids, Recurrence, children, azithromycin