他克莫司联合小剂量泼尼松治疗Ⅰ、Ⅱ期膜性肾病

A Clinical Study on Tacrolimus Combined with Low Dose of Prednisone in Treating of StageⅠ and Ⅱ Membranous Nephropathy

目的:观察他克莫司联合小剂量泼尼松在治疗Ⅰ、Ⅱ膜性肾病的有效性及安全性。方法:经肾活检证实为膜性肾病的47例患者,按照Ehrenreich和Churg分期法分为膜性肾病Ⅰ期组(21例)及膜性肾病Ⅱ期组(26例),两组均给予他克莫司联合小剂量泼尼松治疗,观察2组的有效性及治疗过程中出现的不良反应等。结果:Ⅰ期膜性肾病组在治疗过程中的血药浓度平均值在5.04～8.50μg/L,Ⅱ期组在4.87～8.54μg/L;Ⅰ和Ⅱ期膜性肾病组总缓解率分别为81%、46%,有显著性差异(P<0.05);膜性肾病Ⅰ、Ⅱ期组患者治疗12个月后24 h蛋白定量、甘油三酯、总胆固醇较治疗前均明显下降(P<0.05),而血浆白蛋白明显上升(P<0.05);Ⅰ期膜性肾病组较Ⅱ期组治疗3个月及6个月时24 h尿蛋白定量明显减少(P<0.05)。结论:他克莫司联合小剂量泼尼松治疗Ⅰ、Ⅱ膜性肾病均可获得较好疗效,Ⅰ期组的完全缓解率、部分缓解率均高于Ⅱ期组,治疗过程中出现不良反应均较少。

Objective： To observe the efficacy and safety of tacrolimus combined with small dose of prednisone in treating patients with stage Ⅰand Ⅱ membranous nephropathy.Methods： Forty-seven patients who were diagnosed as membranous nephropathy by renal biopsy from January 2009 to December 2010 were divided into stageⅠmembranous nephropathy group（group Ⅰ,21 cases）and stage Ⅱ membranous nephropathy group（groupⅡ,26 cases）according to Ehrenreich and Churg staging methods.Therapeutic efficacy and adverse effects in the two groups were observed.Results： Average blood concentration of tacrolimus in groupⅠ was fluctuating between 5.04~8.50 μg/L in the couse of treatment,and that in group Ⅱwas fluctuating between 4.87~8.54 μg/L.Total remission rates of group Ⅰ and group Ⅱ were 81% and 46% respectively,and there was significant difference between the two groups（P0.05）.The levels of 24-hour urinary protein（UP）,triglyceride and cholestrol significantly decreased（P0.05）and albumin significantly increased（P0.05） in both the two groups after treatment for 12 months.UP levels of groupⅠin 3 months and 6 months after treatment were significantly lower than those of group Ⅱ（P0.05）.Conclusions： The efficacy of tacrolimus combined with small dose of prednisone in treating of stageⅠand stage Ⅱmembranous nephropathy is good.Both complete remission rate and partial remission rate of groupⅠare higher than those of group Ⅱ.Adverse reactions in the two groups are not common,and there is no significant difference of adverse reactions between the two groups.