不同质量浓度他克莫司治疗特发性膜性肾病的临床疗效观察

Clinical observation of responses to two plasma concentrations of tacrolimus in treatment of idiopathic membranous nephropathy

目的:观察两种血药质量浓度他克莫司在治疗特发性膜性肾病的临床疗效,为临床合理利用他克莫司提供依据.方法:本研究前瞻性地分析了南部战区总医院肾内科自2017年6月至2019年6月经过肾穿刺活检明确Ⅱ~Ⅲ期特发性膜性肾病诊断、应用他克莫司联合激素治疗的66例患者,收集临床资料,根据他克莫司质量浓度分为低质量浓度组与高质量浓度组,观察患者在两组治疗前后血清白蛋白、尿蛋白水平变化,比对分析两组蛋白尿缓解率与不良反应情况.结果:两组患者的血清白蛋白较治疗前均明显升高,差异有统计学意义(P<0.05),但同治疗期组间比较无统计学意义(P>0.05);两组24 h蛋白尿定量较治疗前均明显降低(P<0.05),但两组患者同治疗期尿蛋白定量水平比较无统计学意义(P>0.05);蛋白尿缓解率方面,高质量浓度组(86.49%)较低质量浓度组(80.34%)偏高,但差异无统计学意义(P>0.05);在药物不良反应方面,高血药质量浓度组(37.50%)出现不良反应率高于低血药质量浓度组(20.59%),但差异无统计学意义(P>0.05).结论:在临床表现为肾病综合征的Ⅱ~Ⅲ期特发性膜性肾病患者中,他克莫司治疗低质量浓度组对比高质量浓度组的蛋白尿缓解率无明显区别,不良反应发生率两组相当,较低的他克莫司质量浓度可以达到临床疗效.

Objective:To observe the clinical responses to two plasma concentrations of tacrolimus in treatment of idiopathic membranous nephropathy(IMN)with nephrotic syndrome,including both efficacy and complication,thus to provide evidence for clinical rational application of tacrolimus.Methods:A total of 66 patients diagnosed with nephrotic syndrome and as IMN through renal puncture biopsy in our hospital was selected.The clinical data and tacrolimus concentration of the patients were collected.The level of serum albumin,urinary protein,cholesterol and serum creatinine(Scr),the remission rate and adverse reactions of patients were observed for comparative analysis.Results:Serum albumin in the two groups was significantly higher than that before treatment,and the difference was not statistically significant(P>0.05).The quantitative level of proteinuria of 24h was significantly lower than that before treatment(P<0.05),but there was no statistical difference in the quantitative level of urinary protein at the same time between the two groups(P>0.05).There was no significant change in Scr level in the two groups during treatment(P>0.05).The cholesterol level of the two groups was significantly reduced(P<0.05),but there was no statistical difference in the cholesterol level of the two groups at the same time(P>0.05).In terms of remission rate,the high concentration group was higher than the low concentration group,but there was no statistical difference between the two groups(P>0.05).In terms of adverse drug reactions,the number of cases of adverse drug reactions was higher in the group with high blood drug concentration than in the group with low blood drug concentration,but the difference between the two groups was not statistically significant.Conclusion:Tacrolimus had good remission rate at both low and high concentration and the incidence of adverse reactions was similar between the two groups.Tacrolimus can achieve clinical efficacy at low concentration.