FK506/MMF联合小剂量泼尼松治疗IgA肾病的效果观察

Effect of low-dose prednisone combined with FK506 or MMF on patients with IgA nephropathy

目的观察小剂量泼尼松联合他克莫司(tacrolimus,FK506)以及泼尼松联合吗替麦考酚酯(mycophernolate mofetil,MMF)在IgA肾病患者的临床疗效。方法选取2012年6月至2017年7月在郑州大学第一附属医院肾脏内科治疗,经肾穿刺确诊为原发性IgA肾病的75例患者。根据治疗方案将患者分为泼尼松+FK506组和泼尼松+MMF组,比较两组24 h尿蛋白定量、人血清白蛋白(Alb)水平、血清肌酐(Scr)水平、血清尿酸(UA)水平、血清葡萄糖水平(Glu)、不良反应发生情况以及疗效。结果治疗3月后,泼尼松+MMF组尿蛋白量高于泼尼松+FK506组,差异有统计学意义(P<0.05),但两组Scr、UA、Alb、Glu水平差异无统计学意义(P>0.05)。两组不良反应发生率(17.9%比11.1%)比较,差异无统计学意义(P>0.05)。泼尼松+FK506组完全缓解率高于泼尼松+MMF组(94.4%比66.7%),差异有统计学意义(P<0.05)。结论在原发性IgA肾病患者中,泼尼松联合FK506与联合MMF均取得了良好的治疗效果,但泼尼松联合FK506降低尿蛋白量效果更好,缓解率更高。

Objective To observe the clinical efficacy of small dose prednisone combined with tacrolimus（ FK506） or Mycophernolate mofetil（ MMF） in patients with IgA nephropathy. Methods Seventy-five patients with primary IgA nephropathy were select from June of 2012 to July of 2017 in the First Affiliated Hospital of Zhengzhou University. According to the treatment,patients were divided into prednisone combined with FK506 group and prednisone combined with MMF group. The 24-hour urinary protein,serum albumin（ Alb） levels,serum creatinine（ Scr） levels,serum uric acid（ UA） levels,serum glucose levels（ Glu）,incidence of adverse reactions and efficacy were compared between the two groups. Results After 3 months of treatment,the prednisone combined with MMF group had higher urinary protein levels and complete remission rate than that of the prednisone combined with FK506 group,and the differences were statistically significant（ P〈0. 05）. But there was no significant difference in the levels of Scr,UA,Alb,Glu and the incidence of adverse reactions between two groups（ P〈0. 05）.Conclusion In patients with primary IgA nephropathy,prednisone combined with FK506 treatment may achieve better effect with a lower serum urinary protein and higher remission rate.