Methylprednisolone pulse plus mizoribine in children with Henoch- Schönlein purpura nephritis
Methylprednisolone pulse plus mizoribine in children with Henoch- Schönlein purpura nephritis
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甲基强的松龙脉冲联合咪唑利宾治疗过敏性紫癜肾炎儿童
DOI：
10.1007/s10067-010-1572-6
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Hosoya M
中科院分区：
文献类型：
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作者：
Kawasaki Y;Suyama K;Hashimoto K;Hosoya M
我们评估甲基强的松龙和尿激酶冲击疗法联合咪唑立宾（MUPM）治疗儿童重症过敏性紫癜性肾炎（HSPN）是否有效。我们研究了12例被诊断为至少ISKDC III型HSPN的患者。所有患者均接受MUPM治疗。前瞻性研究临床特征、病理结果和预后。10名患者（应答者; 9例ISKDC分级为IIIb，1例分级为IVb）用MUPM治疗，而2例患者（无应答者; 2例分级为IVb）由于缺乏应答而停用MUPM。治疗3个月后，尿蛋白排泄量从99.7 ± 37.8 mg/m2/h降至25.9 ± 33.4 mg/m2/h。急性指数和肾小管间质评分分别从第一次活检时的5.8 ± 1.5和3.8 ± 0.6显著降低至第二次活检时的2.3 ± 1.3和1.0 ± 0.8。在最近的随访中，8名反应者的尿液正常，2名有轻微的尿液异常。治疗3个月后，无应答者表现出持续高水平的尿蛋白排泄，MUPM停止。我们的研究表明，MUPM是有效的，以改善蛋白尿和HSPN的组织学严重程度在50%<50% crescents but is not so effective for HSPN in patients with >的新月体患者。
We evaluated whether methylprednisolone and urokinase pulse therapy combined with mizoribine (MUPM) was effective in children with severe Henoch–Schoenlein purpura nephritis (HSPN). We studied 12 patients who had been diagnosed with HSPN of at least ISKDC type III. All patients were treated with MUPM. Clinical features, pathological findings, and prognosis were prospectively investigated. Ten patients (responders; nine with ISKDC grade IIIb and one with grade IVb) were treated with MUPM, whereas MUPM was discontinued due to the lack of response in two patients (non-responders; two with grade IVb). Among responders, urinary protein excretion had decreased significantly from 99.7 ± 37.8 to 25.9 ± 33.4 mg/m2per hour after 3 months of therapy. The acute index and tubulointerstitial scores decreased significantly from 5.8 ± 1.5 and 3.8 ± 0.6 at the first biopsy to 2.3 ± 1.3 and 1.0 ± 0.8 at the second biopsy, respectively. At the most recent follow-up, eight of the responders had normal urine, and two had minor urinary abnormalities. Non-responders demonstrated continued high levels of urinary protein excretion after 3 months of therapy, and MUPM was discontinued. Our study suggests that MUPM is effective in ameliorating the proteinuria and the histological severity of HSPN in patients with <50% crescents but is not so effective for HSPN in patients with >50% crescents.