药物治疗管理对特发性膜性肾病患者疾病缓解的影响

Effect of Medication Therapy Management on Disease Relief in Patients with Idiopathic Membranous Nephropathy

目的对临床药师参与特发性膜性肾病治疗的疗效影响进行回顾性分析。方法嘉兴市第一医院2010年10月—2015年10月特发性膜性肾病患者88例,分为监护组(n=48)和对照组(n=40)。两组均给予激素联合环磷酰胺治疗。临床药师参与监护组患者的药物治疗管理工作,包括建立患者电子档案,合理用药的宣教与测试;个体化给药指导,如激素、抗凝药物、降压药物、调脂药物的合理使用;预防及监测药物不良反应的发生等。观察各组患者临床疗效,治疗前后24 h尿蛋白定量(24hu TP)、血浆白蛋白(Alb)、血肌酐(Scr)、肾小球滤过率估算值(e GFR)、凝血酶原时间(PT)、纤维蛋白原(Fib)、总胆固醇(TC)、三酰甘油(TG)水平的变化及不良反应发生情况。结果治疗前,两组患者的24hu TP、Alb、Scr、e GFR水平及基线资料均差异无统计学意义(P>0.05)。治疗12个月后,监护组24hu TP、Alb、Scr、e GFR水平明显改善,与对照组比较均差异有统计学意义(P<0.01);监护组TC、TG均较治疗前显著下降(P<0.05),对照组无明显变化;对照组PT较治疗前缩短(P<0.05),监护组变化不明显;监护组治疗总有效率高于对照组(P<0.05)。治疗期间常见并发症为糖耐量异常、消化道症状、呼吸道感染,两组差异无统计学意义(P>0.05)。结论开展药学监护管理可使特发性膜性肾病患者获益。

Objective To investigate and analyze the effect of clinical pharmacist participating in the operation mode of medication management in patients with idiopathic membranous nephrology. Methods A total of 88 patients hospititalized in the First Hospital of Jiaxing City from October 2010 to October 2015 were divided into guardianship group（n = 48） and control group（n = 40）. All patients received conventional therapy combined with glucocorticoid and cyclophosphamide. Clinical pharmacists participated in drug management in patients with idiopathic membranous nephropathy. Clinical pharmacists participated in management of drug use in patients with idiopathic membranous nephrology. They carried out patient management,electronic health records,drug guidance and prevention of adverse reactions. The drugs included glucocorticoid,anticoagulants,blood-pressure medications,and lipid-lowering drugs mainly. Clinical efficacy,24 h urinary protein,albumin,serum creatinine,e GFR,fibrinogen,total cholesterol（TC）,triglyceride（TG） before and after treatment and adverse reactions in all groups were observed. Results There were no significant differences in basic data of 24 h urine protein,serum albumin,serum creatinine and e GFR between the two groups pre-treatment. The levels of 24 h urine protein,serum albumin,serum creatinine and e GFR were significantly different between the two groups（P〈0. 01）. The levels of TC and TG in the guardianship group were significantly decreased after the treatment（P〈0.05）. The prothrombin time in the control group was significantly shortened after the treatment（P〈0.05）. The total effective rate in the guardianship group was significantly higher than that in the control group（P〈0.05）. During the treatment period,impaired glucose tolerance,gastrointestinal symptoms and respiratory tract infection were the most common complications. The difference was not statistically significant between the two groups. Conclusion It is beneficial for patients with idiopathic membranous nephropathy to conduct pharmacy guardianship with the participation of clinical pharmacists.