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为研究FK506治疗儿童不同病理类型肾病综合征的临床疗效及意义 ,对12例患儿入院后逐渐减用激素 ,给予口服FK506,剂量0.1～0.15mg/(kg·d) ,疗程3～6月 ,并监测血浓度。结果12例患儿经FK506治疗2个月后 ,完全缓解8例(MCDN4例,MsPGN4例),部分缓解3例(MsPGN1例 ,MPGN1例 ,FSGS1例) ,总有效率91.67% ,无效1例(MsPGN1例) ,显效时间为10～38d。治疗1个月后12例中有9例血清白蛋白升到正常 ,胆固醇、甘油三酯均有不同程度的下降 ,2个月后11例患儿生化指标恢复正常 ;FK506有效血浓度维持在5～12ng/ml;治疗过程中出现胃肠道症状3例 ,一过性尿肌酐增加2例 ,NAG轻微增加3例 ;2例患儿随访仅2例复发。提示用小剂量皮质激素与FK506联合使用 ,以及在FK506减量时加用作用较轻的免疫抑制剂维持 ,可起到巩固疗效、防止复发的作用。因此 ,FK506有可能成为治疗肾病综合征的有效方法。
In order to study the clinical efficacy and significance of FK506 in treating children with different pathological types of nephrotic syndrome, 12 children were admitted to hospital with gradual reduction of hormones and oral administration of FK506 at doses of 0.1-0.15 mg / (kg · d) for 3 to 6 months , And monitor blood concentration. Results After 12 months of treatment with FK506, 8 cases were completely relieved (4 cases of MCDN and 4 cases of MsPGN), 3 cases of partial remission (1 case of MsPGN, 1 case of MPGN and 1 case of FSGS), the total effective rate was 91.67% and 1 case was ineffective MsPGN1 cases), effective time is 10 ~ 38d. Nine months after treatment, 9 cases of serum albumin rose to normal, cholesterol and triglyceride decreased in varying degrees. After 2 months, the biochemical indexes of 11 children returned to normal. The effective blood concentration of FK506 was maintained at 5 ~ 12ng / ml; 3 cases of gastrointestinal symptoms during treatment, 2 cases of transient urinary creatinine increased, 3 cases of NAG increased slightly; 2 cases of children were followed up only 2 cases of recurrence. Prompt use of small doses of corticosteroids and FK506 combined, as well as the role of FK506 plus a lesser amount of immunosuppressive agents to maintain, can consolidate the efficacy and prevent recurrence. Therefore, FK506 may be an effective treatment for nephrotic syndrome.