Mizoribine treatment for childhood IgA nephropathy
Mizoribine treatment for childhood IgA nephropathy
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DOI：
10.1046/j.1328-8067.2001.01532.x
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发表时间：
2002-04-01
影响因子：
1.4
通讯作者：
Yamashiro, Y
中科院分区：
文献类型：
--
作者：
Nagaoka, R;Kaneko, K;Yamashiro, Y
背景：目前还没有确定的治疗儿童IgA肾病（IgAN）的方法。米佐利滨是一种安全、耐受性良好的新型免疫抑制剂，已广泛应用于多种疾病。我们的初步研究表明，米佐利滨可以减少IgAN患儿的蛋白尿量。目前的研究是为了证实这一发现。方法：纳入10例组织学严重程度中等的IgAN患儿（中位年龄13.5岁）。他们之前都没有接受过免疫抑制剂治疗。口服米佐利滨的中位疗程为20.5个月。我们比较了以尿蛋白与尿肌酐比值（UP/UC）表示的尿蛋白排泄量和以潜血水平（OB评分）评价的血尿量。在治疗前后使用配对活检标本对3例患者进行肾脏组织学检查。我们定期进行血液检查，监测米佐利滨的毒性和血药浓度。结果：中位观察时间为44.5个月，其中治疗前13.0个月，治疗中20.5个月，治疗后12.0个月。米佐瑞滨可显著降低UP/UC和OB评分（P < 0.05）。肾系膜增生也有改善。米佐利滨的血浆峰值水平从0.30 μ g/mL到1.23 μ g/mL不等，与其有效性无关。在治疗期间没有观察到不良反应，尽管白细胞计数略有下降。结论：与传统免疫抑制剂相比，米佐利滨可以显著减少蛋白尿和血尿，并改善组织学，引起的并发症少得多，因此可以作为中度严重儿童IgAN的替代药物。
Background: There is currently no established therapy for childhood IgA nephropathy (IgAN). Mizoribine, a newly developed immunosuppressive agent characterized as a safe and well-tolerated drug, has been widely used in diverse conditions. Our preliminary study demonstrated that mizoribine could reduce the amount of proteinuria in children with IgAN. The present study was conducted to confirm this finding.Methods: Ten children with IgAN (median age 13.5 years) of moderate histological severity were enrolled. None of them had been previously treated by immunosuppressants. Mizoribine was administered orally for a median period of 20.5 months. We compared the urinary protein excretion expressed as the ratio of urinary protein to urinary creatinine (UP/UC) and the hematuria evaluated as the level of occult blood by dip-stick (OB score). Renal histology was also examined in three patients using paired biopsy specimens obtained both before and after treatment. We performed blood examinations regularly to monitor the toxicity and plasma concentration of mizoribine.Results: The median observation period was 44.5 months, consisting of a median 13.0 months before therapy, 20.5 months during therapy and 12.0 months after therapy. Significant reductions in both UP/UC and OB score were induced by mizoribine (P < 0.05). Renal mesangial proliferation was also improved. Plasma peak levels of mizoribine varied from 0.30 mu g/mL to 1.23 mu g/mL and were not associated with its effectiveness. No adverse effects were observed during the therapy, although a slight decrease in leukocyte count was noted.Conclusion: Mizoribine can be an alternative drug for childhood IgAN with moderate severity because it results in a significant reduction of proteinuria and hematuria with histological improvement and causes far fewer complications compared to the conventional immunosuppressants.