根据最新一期儿科杂志(Pediatrics, published on line Aug.15)在线发表的一项随机对照临床试验结果，辅助口服甲强龙可能降低住院儿童急性肾盂肾炎肾脏瘢痕的发生率和严重程度。
“急性肾盂肾炎后的肾脏瘢痕常伴有长期后遗症”，台湾国立成功大学医学院及附属医院儿科的Ya-Yun Huang博士在文中写道，“预防急性肾盂肾炎后瘢痕形成不仅需要依靠提前诊断和快速治疗以根除细菌，还需要减轻严重的炎症反应。”
该研究的目的是考察在低于16岁的儿童患者第一阶段急性肾盂肾炎过后，糖皮质激素是否可抑制肾脏瘢痕形成的高风险。入选标准是在锝-99M标记的DMSA扫描(dimercaptosuccinic acid scan)中炎性体积至少4.6 mL或有肾脏超声影像异常。
共84名参加者入选，随机分配接受抗生素+甲强龙磷酸盐(1.6 mg/kg/day; n = 19)或抗生素+安慰剂(n=65)治疗，6 h每天，共3天。试验主要终点为治疗6月后DMSA检测的肾脏瘢痕形成状况。
试验开始前，两组患者特征，急性炎症指标及DMSA检查结果相似。治疗6个月后，33.3%接受甲强龙治疗的儿童肾DMSA检查出现瘢痕，安慰剂组检出比例为60.0%(P<0.05)，两组中位皮质缺损体积分别为0.0 mL (范围0-4.5 mL)和1.5 mL(范围0-14.8 mL)(P<0.01)。与安慰机组相比，口服甲强龙患者治疗后退烧速度也较快。
研究结果表明，对于急性肾盂肾炎后肾脏瘢痕形成高风险住院的儿童，合并口服甲强龙治疗可减少或减轻肾脏瘢痕形成的发生率和严重程度。
本研究的局限性是在一个单中心三级医院中进行，范围较小，某些亚级分组病人数目较少以及在鉴别肾脏瘢痕形成高风险患者中方法不一致。
尽管如此，研究人员总结到，该研究结果仍然很有前景，应该设计更大规模的研究以验证药物的作用并优化皮质激素类用药剂量，并确定最大获益儿童的年龄。合并口服甲强龙与适当的抗生素疗法在未来对减轻患急性肾盂肾炎儿童的永久性组织损伤是一种潜在有效的疗法。(编译自Medscape)
国立成功大学(台南)及 National Science Council(台北)支持了本研究。研究者声称无其他利益冲突。
附：原文摘要
原文标题：Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring
期刊来源：Pediatrics, published on line Aug.15
期刊影响因子：4.726
PMID：21844061
Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring
Objective: To determine if glucocorticoids can prevent renal scar formation after acute pyelonephritis in pediatric patients.
Methods: Patients younger than 16 years diagnosed with their first episode of acute pyelonephritis with a high risk of renal scar formation (ie, inflammatory volume ≥ 4.6 mL on technetium-99m–labeled dimercaptosuccinic acid scan [DMSA] or abnormal renal ultrasonography results) were randomly assigned to receive either antibiotics plus methylprednisolone sodium phosphate (1.6 mg/kg per day for 3 days [MPD group]) or antibiotics plus placebo (placebo group) every 6 hours for 3 days. Patients were reassessed by using DMSA 6 months after treatment. The primary outcome was the development of renal scars.
Results: A total of 84 patients were enrolled: 19 in the MPD group and 65 in the placebo group. Patient characteristics were similar between the 2 groups, including the acute inflammatory parameters and the initial DMSA result. Renal scarring was found in 33.3% of children treated with MPD and in 60.0% of those who received placebo (P < .05). The median cortical defect volumes on follow-up DMSA were 0.0 mL (range: 0–4.5 mL) and 1.5 mL (range: 0–14.8 mL) for the MPD and placebo groups, respectively (P < .01). Patients in the MPD group experienced faster defervescence after treatment than the placebo group.
Conclusions: Adjunctive oral MPD therapy reduced the occurrence and/or severity of renal scarring after acute pyelonephritis in these hospitalized children who had a high risk of renal scar formation.
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