小剂量泼尼松联合他克莫司治疗特发性膜性肾病的临床价值

Clinical Value of Low Dose Prednisone Combined With Tacrolimus in the Treatment for Idiopathic Membranous Nephropathy

目的探讨小剂量泼尼松联合他克莫司对特发性膜性肾病的临床价值。方法选取本院2015年2月—2017年6月肾穿刺活检提示膜性肾病(PLA2R+Ig G4荧光免疫染色为阳性)患者102例,肾功能正常,24小时尿蛋白定量均大于4 g,且经过6个月保守治疗后,未见自发缓解。采用随机数字表法分为两组,对照组患者(51例)采用改良Ponticelli方案(第1、3、5个月初给予甲泼尼龙0.5 g,每日1次,连用3天,随后隔日口服泼尼松0.5 mg/kg,并于第2、4、6个月开始,每月静脉滴注环磷酰胺0.8~1.0 g,总量6~8 g)。观察组患者(51例)采用小剂量泼尼松0.15 mg/(kg·d)联合他克莫司0.05mg/(kg·d)治疗,血药浓度保持在5~10 ng/ml。比较两组患者临床指标改善情况、临床疗效、用药安全性。结果治疗后,两组患者尿蛋白、血肌酐、甘油三酯、总胆固醇降低,血清白蛋白、内生肌酐清除率增加,差异具有统计学意义(P<0.05)。观察组患者尿蛋白、血肌酐、甘油三酯、总胆固醇、不良反应发生率低于对照组,清白蛋白、内生肌酐清除率、总有效率高于对照组,差异具有统计学意义(P<0.05)。结论小剂量泼尼松联合他克莫司治疗特发性膜性肾病的疗效显著且安全高。

Objective To investigate clinical value of low dose prednisone combined with tacrolimus in the treatment for idiopathic membranous nephropathy. Methods 102 patients with idiopathic membranous nephropathy confirmed by renal biopsy（PLA2 R ＋ Ig G4 immunofluorescence staining was positive） who were selected in hospital from February 2015 to June 2017, while renal function was normal, 24 h urine protein was more than 4 g, no spontaneous remission was found after conservative treatment 6 months. Patients were divided into two groups by random number table method. 51 patients treated improved Ponticelli scheme（first, third, fifth month at the beginning of 0.5 g qd treated with methylprednisolone for 3 days, followed by oral prednisone 0.5 mg/kg every day, and then second, fourth, sixth month at the beginning of intravenous cyclophosphamid 0.8-1.0 g monthly, total 6-8 g） as control group. 51 patients treated low dose prednisone 0.15 mg/（kg·d） combined with tacrolimus 0.05 mg/（kg·d） as observation group, whose blood drugconcentration were kept at 5-10 ng/ml. The improvement of clinical indexes, clinical efficacy, drug safety were compared between two groups. Results After treatment, the urine protein, serum creatinine, triglyceride and total cholesterol in the two groups were decreased, and the clearance rate of serum albumin and endogenous creatinine increased. The difference was statistically significant（P〈0.05）. The rate of urine protein, serum creatinine, triglyceride, total cholesterol and adverse reaction in theobservation group was lower than that of the control group. The clearing rate of albumin and endogenous creatinine and the total effective rate were higher than those in the control group, the difference was statistically significant（P〈0.05）. Conclusion Low dose prednisone combined with tacrolimus have significant effect and high safety in treatment for idiopathic membranous nephropathy.