雷公藤多苷片联合小剂量他克莫司及糖皮质激素治疗特发性膜性肾病患者疗效及对血栓弹力图影响

Curative effect of tripterygium glycosides combined with low-dose tacrolimus and glucocorticoids on idiopathic membranous nephropathy and its effect on thromboelastography

目的探讨雷公藤多苷片联合小剂量他克莫司及糖皮质激素治疗特发性膜性肾病患者疗效及对血栓弹力图的影响。方法将2017年1月—2018年1月保定市第二中心医院诊治的60例特发性膜性肾病患者随机分为2组,对照组30例给予小剂量他克莫司及糖皮质激素治疗,观察组30例于对照组基础上联合给予雷公藤多苷片治疗。观察2组治疗前后肾功能相关指标、血栓弹力图检查相关指标变化情况,统计2组疗效及不良反应发生情况。结果2组治疗6个月后24 h尿蛋白定量(UP)、血肌酐(SCr)水平均明显降低(P均<0.05),血清白蛋白(ALB)、肾小球滤过率(eGFR)均明显升高(P均<0.05),且观察组UP、SCr水平及凝固角(α角)、凝血指数(CI)均明显低于对照组(P均<0.05),ALB、eGFR及反应时间(R值)、凝血时间(K值)均明显高于对照组(P均<0.05);观察组治疗后总有效率为93.3%(28/30),对照组为70.0%(21/30),观察组治疗后总有效率显著高于对照组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论雷公藤多苷片联合小剂量他克莫司及糖皮质激素治疗特发性膜性肾病患者疗效较佳,可明显改善肾功能及高凝状态,安全性良好。

Objective It is to investigate the curative effect of tripterygium glycoside tablets combined with low-dose tacrolimus and glucocorticoid in the treatment of patients with idiopathic membranous nephropathy and its effect on thromboelastography.Methods Sixty 60 patients with idiopathic membranous nephropathy diagnosed and treated in The Second Central Hospital of Baoding from January 2017 to January 2018 were randomly divided into 2 groups,30 patients in the control group were treated with low-dose tacrolimus and glucocorticoids,30 patients in the observation group were treated with tripterygium glycosides based on the control group.The changes of related indexes of renal function and thromboelastography before and after treatment were observed in the two groups,and the efficacy and adverse reactions of the two groups were evaluated or calculated.Results The 24 h urine protein quantification(UP),serum creatinine(SCr)level were significantly reduced(P<0.05),serum albumin(ALB),and glomerular filtration rate(eGFR)were significantly increased in the two groups after 6 months of treatment,and the UP,SCr,coagulation angle(αangle),and coagulation index(CI)of the observation group were significantly lower,while ALB,eGFR,response time(R value),and clotting time(K value)were significantly higher than those in the control group(P<0.05);the total effective rate in the observation group after treatment was significant higher than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Tripterygium glycosides combined with low-dose tacrolimus and glucocorticoids which can significantly improve renal function,lipid metabolism and hypercoagulabilityare more effective and safe in treating patients with idiopathic membranous nephropathy.