他克莫司联合激素治疗IgA肾病伴黏膜感染患者的效果观察

Effect observation of tacrolimus combined with hormone on patients with IgA nephropathy and mucosal infection

目的研究探讨他克莫司联合激素治疗免疫球蛋白A(IgA)肾病伴黏膜感染患者的临床效果。方法125例IgA肾病伴黏膜感染患者,根据随机数字表法分为对照组(60例)和观察组(65例)。两组均给予血管紧张素受体拮抗剂、血管紧张素转化酶抑制剂,在此基础上,对照组给予糖皮质激素治疗,观察组在对照组基础上加用他克莫司治疗。观察比较两组临床疗效、治疗前后肾功能指标(尿素氮、血肌酐、24h尿蛋白)、血清炎症因子指标[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、血管内皮功能指标[血管内皮生长因子(VEGF)、内皮素-1(ET-1)]以及不良反应发生情况。结果观察组治疗总有效率95.38%明显高于对照组的81.67%,差异具有统计学意义(P<0.05);两组治疗后尿素氮、血肌酐、24h尿蛋白水平均低于治疗前,且观察组均低于对照组,差异具有统计学意义(P<0.05);两组治疗后hs-CRP、IL-6、TNF-α水平均低于治疗前,且观察组均低于对照组,差异具有统计学意义(P<0.05);两组治疗后VEGF、ET-1水平均低于治疗前,且观察组均低于对照组,差异具有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论他克莫司与糖皮质激素联合用于IgA肾病伴黏膜感染患者治疗中具有良好的临床疗效和用药安全性,可更好地改善肾功能和血管内皮功能,减轻机体炎症反应。

Objective To study the clinical effect of tacrolimus combined with hormone on patients with immunoglobulin A (IgA) nephropathy and mucosal infection. Methods A total of 125 IgA nephropathy patients with mucosal infection were divided by random number table method into control group (60 cases) and observation group (65 cases). Both groups received angiotensin receptor antagonist and angiotensin converting enzyme inhibitor. On this basis, the control group was treated with glucocorticoid, and the observation group was treated with tacrolimus on the basis of the control group. Observation and comparison were made on clinical efficacy, renal function indicators (urea nitrogen, serum creatinine, 24 h urinary protein) before and after treatment, serum inflammatory factors indicators [ hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α)], vascular endothelial function indicators [ vascular endothelial growth factor (VEGF), endothelin-1 (ET -l)]and occurrence of adverse reactions between the two groups. Results The total effective rate of treatment in the observation group was 95.38%, which was obviously higher than 81.67% in the control group, and the difference was statistically significant (P<0.05). The urea nitrogen, serum creatinine and 24 h urinary protein after treatment were all lower than those before treatment, and the indicators in the observation group were all lower than those in the control group. Their difference was statistically significant (P<0.05). The hs-CRP, IL -6 and TNF-α after treatment were all lower than those before treatment, and the indicators in the observation group were all lower than those in the control group. Their difference was statistically significant (P<0.05). The VEGF and ETT-1 after treatment were all lower than those before treatment, and the indicators in the observation group were all lower than those in the control group. Their difference was statistically significant (P<0.05). There was no statistically significant in incidence of adverse reactions between the two groups (P>0.05). Conclusion Tacrolimus combined with glucocorticoids has good clinical efficacy and safety in IgA nephropathy patients with mucosal infection. It can better improve renal function and vascular endothelial function, and alleviate inflammatory reaction.