Vincristine treatment in steroid-dependent nephrotic syndrome
Vincristine treatment in steroid-dependent nephrotic syndrome
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DOI：
10.1007/s00467-005-1940-7
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发表时间：
2005-10-01
影响因子：
3
通讯作者：
Powell, HR
中科院分区：
文献类型：
--
作者：
Kausman, J;Yin, L;Powell, HR
激素依赖性肾病综合征（SDNS）儿童的治疗仍然是一个挑战，当复发复发与环磷酰胺治疗后，副作用或不遵守使类固醇和环孢素不令人满意。我们对12例SDNS患者静脉注射长春新碱，剂量为1-1.5 mg/m2，每周1次，持续4周，然后每月1次，持续4个月。开始长春新碱治疗时复发的5例患者中有4例在2次给药内缓解。比较长春新碱治疗前后12个月的复发频率，每年复发从4例减少至1.5例（p=0.004）。中位持续缓解时间为5个月，但1例频繁复发患者在长春新碱治疗后4年仍处于缓解状态。在5名患者中，每周间隔1次或2次使用阿贝斯汀也成功治疗了随后的复发。在大多数情况下，副作用很小。2例患者在开始长春新碱1.5 mg/m（2）时发生腹痛，但在继续1 mg/m（2）时消退。我们认为长春新碱对一部分患有挑战性SDNS的儿童有作用，每周1 mg/m2，持续4周，然后每月1.5 mg/m2，持续4个月。阿曲斯汀允许类固醇和环孢霉素节省，有助于长期缓解，在一些患者中，特别是在儿童与口服药物依从性差的价值。许多患者表示更喜欢使用少量长春新碱，而不是口服泼尼松龙或环孢菌素的标准疗程。
Treatment of children with steroid-dependent nephrotic syndrome (SDNS) continues to be a challenge when relapses recur after treatment with cyclophosphamide and side effects or non-compliance make steroids and cyclosporin unsatisfactory. We treated 12 patients with intravenous vincristine for SDNS in a regime of 1-1.5 mg/m(2) weekly for 4 weeks then monthly for 4 months. Four of the 5 patients in relapse when commencing vincristine remitted within 2 doses. Comparing relapse frequency in the 12 months before and after vincristine, there was a reduction from 4 to 1.5 (p=0.004) relapses per year. Median sustained remission was 5 months, but 1 frequently relapsing patient remains in remission 4 years after vincristine. Vincristine was also successfully used in 1 or 2 doses at weekly intervals for subsequent relapses in 5 patients. Side effects were minimal in most cases. Abdominal pain occurred in 2 patients who commenced vincristine at 1.5 mg/m(2), but resolved when continued at 1 mg/m(2). We felt vincristine had a role in a subset of children with challenging SDNS administered as 1 mg/m(2) weekly for 4 weeks then 1.5 mg/m(2) monthly for 4 months. Vincristine allowed steroid- and cyclosporin-sparing, contributed to long-term remission in some patients, and was especially valuable in children with poor compliance with oral medication. Many patients expressed a preference for a few doses of vincristine rather than a standard course of oral prednisolone or cyclosporin.