他克莫司、雷公藤多苷多靶点治疗特发性膜性肾病疗效观察

Therapeutic Effect of Tacrolimus and Tripterygium Glycosides in the Treatment of Idiopathic Membranous Nephropathy

目的:观察他克莫司、雷公藤多苷多靶点治疗特发性膜性肾病的疗效。方法:76例特发性膜性肾病患者随机分为对照组和观察组各38例。对照组患者给予常规治疗(环磷酰胺+泼尼松),观察组患者给予多靶点治疗(他克莫司+雷公藤多苷+环磷酰胺+泼尼松)。治疗3个月后,观察两组的疗效和药品不良反应,比较两组患者治疗前后肾功能、性激素水平、炎性因子水平变化。结果:观察组总缓解率为78.94%,明显高于对照组的55.26%(P<0.05)。治疗后,两组患者血清白蛋白均较前明显升高,尿蛋白较前明显降低(P<0.05),且观察组上述指标均优于对照组(P<0.05)。治疗后,两组血清E2、T、SHBG等激素水平均较前显著降低,FSH、LH水平则显著升高(P<0.05);但观察组各项指标优于对照组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:特发性膜性肾病患者行他克莫司、雷公藤多苷多靶点治疗,疾病缓解率高,肾功能恢复较好,且患者性激素水平波动较小,安全性较高,建议临床推广。

Objective:To observe the therapeutic effect of tacrolimus and tripterygium glycosides in the treatment idiopathic membranous nephropathy.Methods:Totally 76 patients with idiopathic membranous nephropathy were randomly divided into the control group and the study group,38 patients in each group.The patients in the controll group were treated with routine treatment(cyclophosphamide and prednisone),and the patients in the study group were treated with the multi-target treatment(tacrolimus,tripterygium glycoside,cyclophosphamide and prednisone).After 3 month treatment,the differences in the therapeutic effect,renal function,sex hormone level,inflammatory factors and adverse reactions between the two groups were observed.Results:After the treatment,the total remission rate of the patients in the study group(78.94%)was significantly higher than that in the control group(55.26%),and the difference was statistically significant(P<0.05);the serum albumin of the two groups were significantly increased than before,and the urinary protein was significantly decreased than before(P<0.05),and that in the study group was better than that in the control group(P<0.05).The levels of serum E2,T,SHBG and the other hormones in the two groups after the treatment were significantly decreased than before,while the levels of FSH and LH were significantly increased(P<0.05),and those in the study group were better than those in the control group(P<0.05).Conclusion:Tacrolimus and tripterygium glycoside can be used in patients with idiopathic membranous nephropathy with small fluctuation of sex hormone levels,promising renal function recovery,good safety and high disease relief rate,therefore,it is recommended to be popularized in clinical practice.