小剂量他克莫司联合激素治疗难治性肾病综合征

Small dose of tacrolimus combined with hormone in the treatment of refractory nephrotic syndrome

目的:观察小剂量他克莫司(TAC)联合激素治疗难治性肾病综合征(RNS)的安全性和临床疗效。方法:前瞻性研究20例难治性肾病综合征患者,研究开始时激素调整至0.5mg·kg-1·d-1,维持8周并逐渐减量,同时服用小剂量TAC,根据TAC血药浓度及临床疗效调整用药剂量,定期随访肝肾功能、24小时尿蛋白、TAC血药浓度等生化指标,并记录不良反应。结果:治疗第2周开始患者的尿蛋白定量减轻,血浆白蛋白水平开始有所恢复,治疗前后结果差异有统计学意义(P<0.05)。20例患者在小剂量TAC联合激素治疗后均有不同程度缓解,5例在缓解期药物减量过程中复发,TAC重新加量至原剂量后2例缓解,另3例无反应,其中1例死亡;2例在感染后复发,TAC加量后不缓解,13例处于缓解期已9月余,TAC剂量减量后尚在随访中。完全缓解率75%,病死率5%,复发率20%。结论:小剂量TAC联合激素能使难治性肾病综合征患者得到较快缓解,复发及治疗效果与病理类型有关,其不良反应少,安全性好。

To observe the clinical effi cacy and safety of small dose of tacrolimus （TAC） combined with hormone in the treatment of refractory nephrotic syndrome （ RNS ）. METHODS： 20 cases of prospective study of re fractory nephrotic syndrome patients, when the study began hormone dosage adjustment to 0. 5 mg. kg-1 . d-1, for 8 weeks and gradually reduced, while taking a low dose of TAC, ac cording to TAC serum concentration and clinical efficacy of adjusting dosage, regular follow-up liver function, 24 hour urinary protein, blood plasma TAC concentration and other biochemical indexes, and record adverse reactions. RE- SULTS：After second weeks to reduce proteinuria patients, plasma albumin level began to be re covered, there was statistically significant differ ence （P〈0.05） before and after. 20 patients had different degree of ease in small dose of TACcombined with corticosteroid therapy, 5 cases in remission stage drug reduction process, TAC to add weight to the original dose relieved in 2 ca- ses, the other 3 cases without response, inclu ding 1 cases of death;In 2 cases of infection re currence, TAC amount does not relieve, 13 pa tients in remission was 9 months, TAC dose re duction is still in follow-up. Complete remission rate was 75%, the mortality rate was 5%, the relapse rate was 200%. CONCLUSION： Low dose of TAC combined with hormone can make the refractory nephrotie syndrome patients were re lieved quickly, recurrence and treatment effect is related to the pathologic type, the less adverse reaction, good safety, and provides a new meth od for the treatment.