他可莫司联合小剂量激素治疗IgA肾病效果观察

Clinical efficacy of tacrolimus combined with small doesof hormone therapy on IgA nephropathy

目的:观察他克莫司联合小剂量激素治疗IgA肾病的临床疗效。方法:将25例IgA肾病患者随机分为2组,单纯激素组(n=14)和联合治疗组(n=11);前者给予单纯激素治疗,后者给予他克莫司联合小剂量激素治疗。分别监测治疗前及治疗后10 d,1,2,4,6个月的血压、24 h尿蛋白量、血常规、肝功能、肾功能、不良反应以及他克莫司的血药浓度变化等,维持他克莫司血药浓度为3～5μg/L。结果:联合治疗组在起效时间、完全缓解率等方面均优于单纯激素治疗组;比较两组血压、血肌酐、血糖等,差异无统计学意义。在治疗各个阶段他克莫司血药浓度为3.76～4.35μg/L,呈平稳波动。结论:他克莫司的血药浓度控制在3.76～4.35μg/L时,联合小剂量激素治疗IgA肾病起效快、临床缓解率高。

Objective： To study the clinical efficacy and safety of tacrolimus combined with glucocorticoid on IgA nephropathy patients with moderate proteinuria.Methods： Twenty-five patients with IgA nephropathy were enrolled in the study and were randomly divided into two groups：single hormone group,14 cases were given single glucocorticoid treatment;combined treatment group,11 cases were given tacrolimus combined with glucocorticoid treatment.The changes of 24 h urine protein,aminotransferase,serum creatinine,serum glucose,blood pressure,treatment effects,and side effects were observed and compared between two groups before and 10 d,1 month,2 month,4 month,6 month after treatment.Results： There were no significant differences between two groups with regard to side effects of treatment;and the effect of tacrolimus combined with glucocorticoid were better than taking glucocorticoid singly on IgA nephropathy.Conclusion： When tacrolimus blood concentration fluctuates at 3.76-4.35 μg/L,it takes effect more quickly on IgA nephropathy patients with moderate proteinuria and has higher clinical remission rate.