他克莫司联合小剂量糖皮质激素治疗免疫球蛋白A肾病患者的效果

Efficacy of Tacrolimus Combined with Low-Dose Glucocorticoids in the Treatment of Patients with Immunoglobulin A Nephropathy

目的探讨他克莫司(TAC)联合小剂量糖皮质激素(GC)治疗免疫球蛋白A肾病(IgAN)患者的效果。方法选取2019年3月至2020年8月周口市第六人民医院收治的85例IgAN患者为研究对象,随机分为GC组(42例)、GC联合TAC组(43例)。GC组接受小剂量GC治疗,GC联合TAC组接受TAC联合GC治疗。比较两组疗效、血尿发生率、尿红细胞计数、肾功能[尿素氮(BUN)、肌酐(SCr)、24 h尿蛋白(24 h UP)、胱抑素C(CysC)、估算的肾小球滤过率(eGFR)]、血清磷、钙、炎症因子[白细胞介素4(IL-4)、γ干扰素(IFN-γ)、高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子-α(TNF-α)、单核趋化因子-1(MCP-1)]水平以及血清基质金属蛋白酶-9(MMP-9)、血管内皮细胞生长因子(VEGF)、内皮素-1(ET-1)水平。对比两组不良反应发生率。结果GC联合TAC组总有效率高于GC组(P<0.05);治疗后,GC联合TAC组血尿发生率、24 h UP、CysC、SCr、BUN水平低于GC组,尿红细胞计数少于GC组,eGFR水平高于GC组(P<0.05);治疗后与GC组比较,GC联合TAC组血磷、IL-4、HMGB1、TNF-α、MCP-1、VEGF、ET-1、MMP-9水平降低,血钙、IFN-γ水平升高(P<0.05);GC联合TAC组不良反应发生率与GC组比较,差异无统计学意义(P>0.05)。结论TAC联合小剂量GC治疗IgAN效果确切,能改善患者临床症状、肾功能,减轻炎症反应及肾小管损伤。

Objective To investigate the efficacy of tacrolimus(TAC)combined with low-dose glucocorticoids(GC)in the treatment of patients with immunoglobulin A nephropathy(IgAN).Methods A total of 85 patients with IgAN admitted to the Sixth People’s Hospital of Zhoukou from March 2019 to August 2020 were selected for the study and randomly divided into GC group(42 cases)and GC combined with TAC group(43 cases).The GC group was treated with low-dose GC and the GC combined with TAC group was treated with TAC combined with GC.The efficacy,incidence of hematuria,urine red blood cell count,renal function[blood urea nitrogen(BUN),serum creatinine(SCr),24 hours urine protein(24 h UP),cystatin C(CysC),estimated glomerular filtration rate(eGFR)],serum phosphorus,calcium,inflammatory factors[interleukin 4(IL-4),gamma interferon(IFN-γ),high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α),monoclonal chemokine-1(MCP-1)]and serum matrix metalloproteinase-9(MMP-9),vascular endothelial growth factor(VEGF),endothelin-1(ET-1)levels were compared between the two groups.The incidence of adverse reactions was compared between the two groups.Results The total effective rate in GC combined with TAC group was higher than that in GC group(P<0.05).After treatment,the incidence of hematuria,24 h UP,CysC,SCr and BUN levels in GC combined with TAC group were lower than those in GC group,urine red blood cell count was less than that in GC group,and eGFR level was higher than that in GC group(P<0.05).After treatment,compared with GC group,the levels of blood phosphorus,IL-4,HMGB1,TNF-α,MCP-1,VEGF,ET-1 and MMP-9 were lower and the levels of blood calcium and IFN-γwere higher in the GC combined with TAC group(P<0.05).There was no statistical difference in the incidence of adverse reactions between the GC combined with TAC group and the GC group(P>0.05).Conclusion TAC combined with low-dose GC was effective in treating IgAN,improving patients’clinical symptoms,renal function,reducing inflammatory response and mitigating renal tubular injury.