Objective To observe the efficacy and safety of multi-target immunosuppressive therapy by Mycophenolate mofetil (MMF) and Tripterygium wilfordii polyglycoside (TWP) in treatment of children with refractory nephritic syndrome. Methods Thirty-two pediatric patients with refractory nephritic syndrome were orally given MMF 25 mg/(kg·d) and TWP 1 mg/(kg·d) in addition of the comprehensive treatment; thirty pediatric patients with refractory nephritic syndrome were treated by Cyclophosphamide; twenty-seven pediatric patients with refractory nephritis syndrome were treated with MMF. The adverse events were closely observed. The 24 h urinary protein, serum albumin, and renal function were compared among three groups after 6 months of the treatment. Results In 32 patients treated by MMF and TWP, the 24 h urinary protein was decreased and 24 patients hod a 24 h urinary protein below 05 g/24 h; the serum albumin and renal function returned to normal; the total effective rate was 75% that was significantly higher (P < 0.05) when compared with patients treated by Cyclophosphamide or MMF only. The rate of adverse events was not significant different between three groups. Conclusions The multi-target immunosuppressive therapy in children with refractory nephritic syndrome by MMF and TWP offered better efficacy and safety.%目的 探讨应用吗替麦考酚酯联合雷公藤多苷多靶点免疫抑制治疗儿童难治性肾病综合征的疗效及安全性.方法 32例难治性原发性肾病综合征患儿,在综合治疗基础上给予吗替麦考酚酯25 mg/(kg·d)、雷公藤多苷1 mg/(kg·d)口服治疗,同期选取30例应用环磷酰胺冲击治疗和27例只应用吗替麦考酚酯的难治性肾病综合征患儿作为对照.治疗期间严密观察各组不良反应的发生,治疗6个月时分别测定比较患儿的24h尿蛋白定量、血清白蛋白、血肌酐.结果 多靶点免疫抑制组患儿24h尿蛋白均有下降,其中24例尿蛋白＜0.5 g/24 h,血清白蛋白恢复正常,肾功能正常,总有效率为75％,与环磷酰胺冲击组及单独应用吗替麦考酚酯组比较,疗效差异有统计学意义(P＜ 0.05).多靶点免疫抑制组不良事件发生率与环磷酰胺冲击组及单独应用吗替麦考酚酯组之间的差异无统计学意义(P＞0.05).结论 吗替麦考酚酯联合雷公藤多苷多靶点免疫抑制治疗儿童难治性肾病综合征有较好的疗效及安全性.
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