他克莫司或环孢素联合小剂量皮质激素治疗特发性膜性肾病的疗效观察

Efficacy of Tacrolimus or Cyclosporine combined with low dose corticosteroids in the treatment of idiopathic membranous nephropathy

目的探讨他克莫司或环孢素联合小剂量皮质激素在特发性膜性肾病(IMN)中的临床效果。方法选取2019年1月—2020年1月新余市人民医院诊治的50例IMN患者,依照随机数字表法分为2组,各25例。环孢素(CsA)组采用环孢素软胶囊联合醋酸泼尼松片,他克莫司(TAC)组采用他克莫司胶囊联合醋酸泼尼松片,连续用药1年。对比2组肾小球滤过率(eGFR)、血清白蛋白、胆固醇水平、缓解状况、复发情况与不良反应。结果治疗前,2组eGFR、血清白蛋白与胆固醇水平相比,差异无统计学意义(P>0.05);治疗12个月后,TAC组eGFR、血清白蛋白水平高于CsA组,胆固醇水平低于对照组,差异有统计学意义(P<0.05)。TAC组治疗6个月与12个月缓解率高于CsA组,差异有统计学意义(P<0.05);2组复发率与不良反应发生率相比,差异无统计学意义(P>0.05)。结论TAC联合小剂量皮质激素可有效缓解IMN,改善eGFR、血清白蛋白及胆固醇水平,减少低蛋白血症和高胆固醇血症的发生,值得推广。

Objective To investigate the clinical effect of tacrolimus or cyclosporine combined with low dose corticosteroid in idiopathic membranous nephropathy(IMN).Methods A total of 50 IMN patients diagnosed and treated in our hospital from January 2019 to January 2020 were selected and divided into two groups according to random number table,with 25 cases in each group.The cyclosporine(CsA)group was treated with cyclosporine soft capsule combined with prednisone acetate tablets,and the tacrolimus(TAC)group was treated with tacrolimus capsule combined with prednisone acetate tablets for 1 year.The glomerular filtration rate(eGFR),serum albumin,cholesterol levels,remission status,recurrence status and adverse reactions were compared between the two groups.Results Before treatment,there was no significant difference in eGFR,serum albumin and cholesterol levels between the two groups(P>0.05).After 12 months of treatment,the eGFR and serumalbumin levels in TAC group were higher than those in CsA group,and the cholesterol level in TAC group was lower than that in control group,the difference was statistically significant(P<0.05).The remission rate of TAC group was higher than that of CsA group at 6 and 12 months after treatment,the difference was statistically significant(P<0.05).There was no statistical significance in the recurrence rate and the incidence of adverse reactions between the two groups(P>0.05).Conclusion TAC combined with low dose corticosteroids can effectively alleviate IMN,improve the levels of eGFR,serum albumin and cholesterol,and reduce the incidence of hypoproteinemia and hypercholesterolemia,which is worthy of promotion and application.