倾向性评分配比评估他克莫司联合泼尼松治疗肾病综合征的效果

Effect of Tacrolimus Combined with Prednisone in the Treatment of Nephrotic Syndrome Evaluated by Propensity Score Matching

目的探讨倾向性评分配比(PSM)评估他克莫司联合泼尼松治疗肾病综合征(NS)的临床效果。方法对商丘市第六人民医院2018年1月至2021年2月收治的125例NS患者临床资料进行回顾性分析,将采用他克莫司治疗的68例NS患者纳入对照组,将采用他克莫司联合泼尼松治疗的57例NS患者患者纳入观察组。运用PSM法(1∶1,卡钳值=0.01),基于性别、年龄、体质量指数、病程、合并症及肾功能指标,将对照组与观察组配对,获得组间协变量均衡样本。对比两组治疗2个月结束时临床疗效,并对比治疗前、治疗2个月时肾功能指标[血肌酐(Scr)水平、血尿素氮(BUN)、24h尿蛋白定量(24hUPQ)]、炎症因子水平[肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)]及治疗期间不良反应发生率。结果PSM法配比成功后,两组各30例纳入配对研究,组间临床资料比较,差异无统计学意义(P>0.05);较对照组,观察组治疗总有效率较高,差异有统计学意义(P<0.05);治疗2个月,较治疗前,两组血清Scr、BUN水平及24hUPQ均降低,血清ALB水平升高,且与对照组相比,观察组变化更显著(P<0.05);治疗2个月,较治疗前,两组血清TNF-α、CRP、IL-6水平均降低,且较对照组,观察组更低(P<0.05);对比两组不良反应发生率,差异无统计学意义(P>0.05)。结论运用他克莫司联合泼尼松治疗NS患者可显著提高疗效,改善肾功能,缓解炎症反应,且不增加药物副作用。

Objective To explore the dlinical efficacy of tacrolimus combined with prednisone in the treatment of nephrotic syndrome(NS)evaluated by propensity score matching.Methods The elinical data of 125 patients with NS received by Shangqiu Sixth People's Hospital from January 2018 to February 2021 were retrospectively analyzed.Sixty-eight NS patients treated with tacrolimus were included in the control group,57 NS patients treated with tacrolimus combined with prednisone were included in the observation group.Through PSM method(1:1,caliper value=0.01),the control group was matched with the observation group based on gender,age,body mass index,course of disease,complications and renal function,and the equilibrium samples of covariates between groups were obtained.The clinical efficacy of the two groups at the end of 2 months of treatment were compared,and the renal function indexes[serum creatinine(Scr),blood urea nitrogen(BUN),24 h urinary:protein quantification(24 h UPQ)],inflammatory factor levels[tumor necrosis factor-α(TNF-α),high sensitivity C-reactive protein(hs-CRP),interleukin-6(L-6)]and the incidence of adverse reactions during treatment were compared before and 2 months after treatment.Results After the success of PSM method,30 cases in each group were incuded in the paired study,there was no statistical significant difference in clinical data between groups(P>0.05).Compared with the control group,the total efective rate of the observation group was higher,the difference was staistically significant(P<0.05).After 2 months of treatment,compared with before treatment,the levels of Ser,BUN and 24 h UPQ in both groups were decreased,and the level of serum ALB was increased,and compared with the control group,the changes in the observation group were more significant(P<0.05).After 2 months of treatment,compared with before treatment,the serum TNF-α,CRP,IL-6 levels in both groups were decreased compared with that before treatment,and compared with the control group,the changes in the observation group were more significant(P<0.05).There was no statistical significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Therapeutic regimen of tacrolimus combined with prednisone in patients with NS can signifcantly improve the ffcacy,improve renal function,alleviate inflammatory response,and will not increase the incidence of adverse reactions.