nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-3-72-78nefr-1829Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSСравнительное исследование эффективности цитостатической терапии первого выбора ингибиторами кальцинейрина и ингибиторами синтеза нуклеотидов гормоночувствительного, гормонозависимого и со стероидной токсичностью нефротического синдрома у детейComparison of first choice cytostatic therapy with calcineurin inhibitors and nucleotides synthesis inhibitors in children with steroid-sensitive, steroid-dependent nephrotic syndrome with steroid toxicityhttps://orcid.org/0000-0002-8315-2282НырковаП. А.NyrkovaP. A.

Ныркова Полина Алексеевна, кафедра факультетской педиатрии, аспирант

194100, Санкт-Петербург, ул. Литовская, 2

Тел.: +7(812)416-52-86

Polina A. Nyrkova, Department of Faculty Pediatrics, postgraduated student

194100, St. Petersburg, Litovskaya st. 2

Phone: +7(812)416-52-86

instant2010@mail.ruhttps://orcid.org/0000-0002-9415-4785СавенковаН. Д.SavenkovaN. D.

Проф. Савенкова Надежда Дмитриевна, д-р мед. наук, кафедра факультетской педиатрии, заведующая кафедрой

194100, Санкт-Петербург, ул. Литовская, 2

Тел.: +7(812)416-52-86

Prof. Nadezhda D. Savenkova, MD, PhD, DMed Sci, Head of the Department of Faculty Pediatrics

194100, St. Petersburg, Litovskaya st. 2

Phone: +7(812)416-52-86

Savenkova.n.spb@mail.ruСанкт-Петербургский государственный педиатрический медицинский университетРоссияSaint-Petersburg Pediatric State Medical UniversityRussian Federation2020230420202437278Copyright © Ныркова П.А., Савенкова Н.Д., 20202020Ныркова П.А., Савенкова Н.Д.Nyrkova P.A., Savenkova N.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1829ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить в сравнительном исследовании эффективность цитостатической терапии первого выбора ингибитором кальцинейрина циклоспорином и ингибиторами синтеза нуклеотидов – производными микофеноловой кислоты [микофенолата мофетилом (ММФ)/микофенолатом натрия] рецидивирующего и часто рецидивирующего гормоночувствительного, гормонозависимого и со стероидной токсичностью нефротического синдрома (НС) у детей.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. Проведено катамнестическое исследование с оценкой особенностей дебюта, течения, лечения гормоночувствительного НС у 48 детей [29 мальчиков (60 %) и 19 девочек (40 %)] с рецидивирующим и часто рецидивирующим течением, развитием стероидной зависимости и/или токсичности. В сравнительном исследовании оценена эффективность цитостатической терапии первого выбора ингибитором кальцинейрина (циклоспорином) у 17 пациентов и ингибиторами синтеза нуклеотидов (ММФ, микофенолатом натрия) у 31 пациента по длительности ремиссии НС в течение 6 мес и 1 года после лечения.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Установлены статистически значимые различия в длительности ремиссии НС в течение 6 мес и 1 года после цитостатической терапии первого выбора ММФ/микофенолатом натрия и циклоспорином у детей. Ремиссия НС в течение 6 мес после терапии ММФ/микофенолатом натрия сохранялась в 67,7 % (у 21 из 31 пациента) в отличие от таковой после терапии циклоспорином – в 29,4 % (у 5 из 17 пациентов) (р<0,05). Ремиссия НС в течение 1 года после терапии ММФ/микофенолатом натрия сохранялась в 58,1 % (у 18 из 31 пациента) в отличие от таковой после терапии циклоспорином – в 23,5 % (у 4 из 17 пациентов) (р<0,05). Циклоспориновая токсичность диагностирована из 17 пациентов у 5 (29,4 %): повышение креатинина (1), артериальная гипертензия (3), гиперплазия десен (3) при терапии более 12 мес с обратным развитием при отмене. Побочные эффекты терапии ингибиторами синтеза нуклеотидов наблюдались из 31 пациента только у 1 (3,2 %) в виде лимфопенического криза.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Ремиссия рецидивирующего и часто рецидивирующего гормоночувствительного, гормонозависимого и со стероидной токсичностью НС у детей в течение 6 мес после цитостатической терапии первого выбора ММФ/микофенолатом натрия или циклоспорином сохранялась в 67,7 и 29,4 % соответственно, в течение 1 года – в 58,1 и 23,5 % соответственно. В результате сравнительного исследования статистически достоверно установлено, что ремиссия НС в течение 6 мес и 1 года сохранялась чаще у детей, получавших терапию первого выбора ММФ/микофенолатом натрия.

AIM

AIM. Evaluation in comparative study the efficiency of first choice cytostatic therapy with calcineurin inhibitor cyclosporine A and nucleotide synthesis inhibitormycophenolatemofetil (MMF)/mycophenolate sodium in children with relapsing and frequently relapsing steroid-dependent and steroid-sensitive nephrotic syndrome (NS) with steroid toxicity.

PATIENTS AND METHODS

PATIENTS AND METHODS. Follow-up study with analysis of onset, clinical course and treatment includes 48 children ((29 boys (60 %) и 19 girls (40 %)) with relapsing and frequently relapsing NS, developedsteroid dependence and/or steroid toxicity.The efficiency of first choice cytostatic therapy with calcineurin inhibitor cyclosporine Ain 17 patients and nucleotide synthesis inhibitormycophenolatemofetil (MMF)/mycophenolate sodium in 31 patients is estimated in comparative study by analysis of 6 month remission rate and one year remission rate after treatment.

RESULTS

RESULTS. Statistically significant differences in 6 month and one year remission rate after first choice cytostatic therapy with MMF/ mycophenolate sodium and cyclosporine in children are established. Remission of NS during 6 months after MMF/ mycophenolate sodium treatment was in 67,7 % (in 21 from 31 patients) unlike of that after cyclosporine – in 29,4 % (in 5 from 17 patients) (р<0,05). Remission of NS during one year after MMF/ mycophenolate sodium treatment was in 58,1 % (in 18 from 31 patients) unlike of that after cyclosporine – 23,5 % (in 4 from 17 patients) (р<0,05). Cyclosporine toxicity was diagnosed in 5 from 17patients: increased creatinine (1),arterial hypertension (3), gingival hyperplasia (3) in treatment more than 12 months with reverse development after cancel. Side-effects after nucleotide synthesis inhibitor therapy was dignosed only in 1 from 31 patients (3,2 %) – lymphopenic crisis.

CONCLUSION

CONCLUSION. Remission of relapsing and frequently relapsing steroid-dependent and steroid-sensitive with steroid toxicity NS during 6 months after first choice cytostatic therapy with MMF/ mycophenolate sodium and cyclosporine in children was in 67,7 % and 29,4 % respectively, during one year in 58,1 % and 23,5 % respectively. As the result of comparative study remission during 6 months and one year was statistically significant more often in children after first choice cytostatic therapy with MMF/ mycophenolate sodium.

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The authors declare that there are no conflicts of interest present.