他克莫司联合糖皮质激素治疗特发性膜性肾病的临床效果

Clinical effect of Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

目的观察他克莫司联合糖皮质激素治疗特发性膜性肾病的临床效果。方法选取辽宁省盘锦市中心医院2011年3月～2013年3月收治入院的特发性膜性肾病患者68例,并将其随机分为治疗组与对照组,各34例。两组患者均给予泼尼松片0.5 mg/（kg·d）口服,逐渐减量至10 mg/d维持服用。在此基础上,治疗组给予他克莫司治疗,初始剂量为0.05～0.10 mg/（kg·d）,分2次空腹口服,治疗2周后根据血药浓度调整药物剂量,并维持血药浓度在5～10μg/L,疗程至少12个月。对照组给予静脉滴注环磷酰胺750 mg/m2,每月1次,每月最大剂量不超过1 g,连用6个月,6个月后无效停用,若症状获得缓解,每2个月冲击1次,总剂量不得超过10 g。观察两组临床疗效,检测两组治疗前后各项临床指标（包括尿蛋白、血清白蛋白、胆固醇、三酰甘油、血肌酐）。结果治疗组总有效率（91.18%）显著高于对照组（76.47%）,差异有统计学意义（P〈0.05）。两组治疗后尿蛋白、血清白蛋白、胆固醇、三酰甘油水平[治疗组：（0.83±0.05）g/24 h、（42.12±13.38）g/L、（7.34±2.31）mmol/L、（1.03±0.37）mmol/L;对照组：（2.47±0.43）g/24 h、（36.22±11.54）g/L、（8.25±3.06）mmol/L、（1.34±0.58）mmol/L]与治疗前[治疗组：（6.13±1.35）g/24 h、（23.16±6.41）g/L、（13.56±4.19）mmol/L、（3.51±0.87）mmol/L;对照组：（5.69±1.27）g/24 h、（25.27±7.07）g/L、（14.38±4.59）mmol/L、（4.01±0.96）mmol/L]比较,差异均有统计学意义（均P〈0.05）,且治疗组治疗后尿蛋白、血清白蛋白与对照组比较,差异亦有统计学意义（P〈0.05）。治疗组中出现2例血肌酐轻度升高,1例血糖升高,1例血压升高,1例腹泻,2例脱发。对照组中出现3例血肌酐轻度升高,2例腹泻,4例脱发,无高血糖、高血压发生。两组不良反应发生情况比较,差异无统计学意义（P〉0.05）。结论他克莫司联合糖皮质激素是治疗特发性膜性肾病的有效手段,值得临床推广应用。

Objective To observe the clinical effect of Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy. Methods 68 cases of patients with idiopathic membranous nephropathy admitted to Panjin Central Hospital from March 2011 to March 2013 were chosen and randomly divided into two groups： treatment group and control group, with 34 cases in each group. The patients of both groups were given Prednisone Tablets0.5 mg/（kg·d） orally, decreasing to 10 mg/d gradually and keep taking. On this basis, the treatment group was given Tacrolimus, the initial dosage was 0.05-0.10 mg/（kg·d） orally with an empty belly in twice, after treatment for 2 weeks,the drug dosage was adjusted according to plasma concentration, and keep plasma concentration in 5-10 μg/L, the course was 12 months at least. The control group was given intravenous drip of Cyclophosphamide 750 mg/m2, once a month, the maximum dose of every month was not more than 1 g, lasting for 6 months, if it didn＇t work after treating for6 months, then stopped taking it. If the symptom got better, using it once every 2 months, the total dosage couldn＇t exceed 10 g. The clinical effect of the two groups was observed. The clinical indexes（including urine protein, serum albumin, cholesterol, triacylglycerol, serum creatinine） before and after treatment of the two groups were detected. Results The total effective rate of treatment group（91.18%） was higher than that of control group（76.47%）, the difference was statistically significant（P 〈0.05）. The level of urine protein, serum albumin, cholesterol, triacylglycerol after treatment in both groups [treatment group：（0.83±0.05） g/24 h,（42.12±13.38） g/L,（7.34±2.31） mmol/L,（1.03±0.37） mmol/L;control group：（2.47±0.43） g/24 h,（36.22±11.54） g/L,（8.25±3.06） mmol/L,（1.34±0.58） mmol/L] all had statistically significant differences compared with before treatment [treatment group：（6.13 ±1.35） g/24 h,（23.16 ±6.41） g/L,（13.56 ±4.19） mmol/L,（3.51±0.87） mmol/L; control group：（5.69±1.27） g/24 h,（25.27±7.07） g/L,（14.38±4.59） mmol/L,（4.01±0.96） mmol/L]（all P〈 0.05）. And there were statistically significant differences of urine protein, serum albumin after treatment between the two groups（P 〈0.05）. In the treatment group, there were 2 cases of serum creatinine increasing lightly, 1 case of blood glucose increasing, 1 case of blood pressure increasing, 1 case of diarrhea, 2 cases of baldness.In the control group, there were 3 cases of serum creatinine increasing lightly, 2 cases of diarrhea, 4 cases of baldness,and there were no high blood glucose and high blood pressure. The adverse reactions of the two groups had no statistically significant difference（P 〉0.05）. Conclusion Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy is an effective method, which is worthy of clinical promotion and application.