他克莫司单药治疗对特发性膜性肾病临床症状、辅助性T细胞及不良反应的影响

Effects of Tacrolimus Monotherapy on Clinical Symptoms, Helper T Cells and Adverse Reactions of Idiopathic Membranous Nephropathy

目的 分析他克莫司单药治疗对特发性膜性肾病临床症状、辅助性T细胞及不良反应的影响。方法 选择医院2018年1月-2020年6月诊治的特发性膜性肾病98例,按照治疗方案不同分为对照组(n=46)和观察组(n=52)。对照组患者接受环磷酰胺治疗,观察组患者接受他克莫司单药治疗。比较两组患者临床症状、辅助性T细胞水平、肝功能和不良反应。结果 治疗后,两组患者24h蛋白尿水平较治疗前降低,而血浆白蛋白水平较治疗前升高;其中观察组患者24h蛋白尿、IL-6水平低于对照组(P<0.05),血浆白蛋白水平高于对照组(P<0.05)。治疗后,两组患者Th17、Th1、Th2水平较治疗前降低,其中观察组患者Th17、Th1、Th2水平低于对照组(P<0.05)。治疗后两组患者ALT和AST水平较治疗前无显著表现变化,差异比较无统计学意义(P>0.05);观察组患者在治疗后ALT和AST水平与对照组比较无统计学意义(P>0.05)。观察组患者并发症率高于对照组(P>0.05),差异比较无统计学意义。结论 他克莫司单药治疗特发性膜性肾病能明显减轻患者蛋白尿临床症状,提升辅助性T细胞功能,且不增加其治疗不良反应。

Objective To investigate the effects of tacrolimus monotherapy on clinical symptoms, helper T cells and adverse reactions of idiopathic membranous nephropathy.Methods A total of 98 patients with idiopathic membranous nephropathy in our hospital from January 2018 to June 2020 were enrolled, and divided into two groups according to different treatment methods.Control group(n=46)received prednisone tablets, and observation group received cyclophosphamide.The clinical symptoms, helper T cell levels, liver function and adverse reactions were compared between groups.Results After treatment, there was a decrease in 24 h proteinuria levels, and an increase in IL-6 levels in both groups, and observation group had lower 24 h proteinuria levels as well as higher IL-6 levels than those of control group after treatment(P<0.05).After treatment, the levels of Th17,Th1,and Th2 were decreased in both groups, and were lower in observation group than in control group(P<0.05).ALT and AST levels showed no significant changes in both groups after treatment, and no significant difference was found between groups after treatment(P>0.05).The complication rate of observation group was slightly higher than that of control group, with no statistic difference(P>0.05).Conclusion Application of tacrolimus monotherapy in the treatment of idiopathic membranous nephropathy can effectively ameliorate the clinical symptoms, increase the function of helper T cells without increasing the adverse reactions.