他克莫司联合糖皮质激素治疗男性特发性膜性肾病的疗效和安全性

Efficacy and safety of tacrolimus combined with glucocorticoid in the treatment of male idiopathic membranous nephropathy

目的分析他克莫司联合糖皮质激素治疗男性特发性膜性肾病的疗效和安全性。方法选取2015年3月~2019年8月重庆市黔江中心医院收治的86例特发性膜性肾病男性患者,随机数表法分为两组,每组各43例,均给予糖皮质激素治疗,观察组联合他克莫司治疗;对照组联合环磷酰胺治疗。于治疗前、治疗后第3、6、12个月时检测两组尿蛋白定量、血清白蛋白及性激素6项等指标,比较两组患者临床疗效和不良反应。结果第6个月时观察组疗效优于对照组,差异有统计学意义(P<0.05),而第12个月时两组患者疗效差异无统计学意义(P>0.05)。12个月内两组患者均未复发。观察组第3个月、第6个月时尿蛋白定量较对照组低[(1.35±1.05)g/24 h vs.(4.42±2.76)g/24 h]、[(1.13±0.91)g/24 h vs.(3.68±1.34)g/24 h],而血清白蛋白水平较对照组高[(37.23±5.06)g/L vs.(29.87±9.31)g/L]、[(42.65±5.91)g/L vs.(33.87±7.29)g/L],差异有统计学意义(P<0.05)。治疗前后两组患者血肌酐无明显改善,差异无统计学意义(P>0.05)。观察组第3个月、第6个月及第12个月时睾酮[(447.29±132.45)ng/dl vs.(387.52±121.51)ng/dl]、[(408.36±112.79)ng/dl vs.(298.47±119.26)ng/dl]、[(364.42±132.49)ng/dl vs.(276.33±121.09)ng/dl]及雌二醇[(45.38±7.83)pg/ml vs.(41.29±8.62)pg/ml]、[(40.76±8.52)pg/ml vs.(35.09±6.71)pg/ml]、[(38.35±7.61)pg/ml vs.(31.26±6.92)pg/ml]水平均较对照组高,而卵泡生成激素[(5.11±1.75)mIU/ml vs.(5.91±1.81)mIU/ml]、[(6.02±1.63)mIU/ml vs.(7.05±1.58)mIU/ml]、[(6.95±1.54)mIU/ml vs.(8.24±1.75)mIU/ml]较对照组低,组间比较差异有统计学意义(P<0.05)。治疗后两组患者黄体生成激素均较治疗前明显改变,但组间比较差异无统计学意义(P>0.05)。两组患者治疗前后催乳激素无明显改变,差异无统计学意义(P>0.05)。并发症发生率组间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治疗男性特发性膜性肾病起效快,且对性激素分泌影响较小。

Objective To analyze the efficacy and safety of tacrolimus combined with glucocorticoid in the treatment of idiopathic membranous nephropathy.Methods 86 male patients with idiopathic membranous nephropathy from March 2015 to August 2019 were selected for study,and were divided into two groups according to the random number table method,were all given glucocorticoid treatment,observation group combined with tacrolimus treatment,control group combined with cyclophosphamide treatment,the clinical effect,urinary protein quantity,serum albumin,serum creatinine,sex hormone and adverse reactions of the two groups were compared.Results At the 6th month,the curative effect of the observation group was better than that of the control group(P<0.05),but at the 12th month,there was no significant difference between the two groups(P>0.05).There was no recurrence in the two groups within 12 months.At the third and sixth month,the urine protein quantity of the observation group was lower than that of the control group,while the serum albumin level was higher than that of the control group(P<0.05).There was no significant improvement in serum creatinine before and after treatment(P>0.05).At the 3rd,6th and 12th month,the levels of testosterone and estradiol in the observation group were higher than those in the control group,while the levels of FSH in the observation group were lower than those in the control group(P<0.05).After treatment,luteinizing hormone of the two groups were significantly changed,but there was no significant difference between the two groups(P>0.05).There was no significant change of prolactin in the two groups before and after treatment(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Tacrolimus combined with glucocorticoid has a rapid effecton idiopathic membranous nephropathy,and has little effect on the secretion of sex hormones.