他克莫司联合糖皮质激素治疗Ⅱ~Ⅲ期特发性膜性肾病患者的效果

Effects of Tacrolimus combined with Glucocorticoids in treatment of patients with stage Ⅱ~Ⅲ idiopathic membranous nephropathy

目的:观察他克莫司联合糖皮质激素治疗Ⅱ~Ⅲ期特发性膜性肾病(IMN)患者的效果。方法:选取2019年6月至2022年9月该院收治的84例Ⅱ~Ⅲ期IMN患者进行前瞻性研究,采用单双号法将其分为对照组和研究组各42例。对照组给予环磷酰胺联合糖皮质激素治疗,研究组给予他克莫司联合糖皮质激素治疗,比较两组临床疗效,治疗前后24 h蛋白尿定量、血清总蛋白(ALB)水平,肾功能指标[血肌酐(Scr)、内生肌酐清除率(Ccr)]水平,以及治疗期间不良反应发生率。结果:研究组治疗总有效率为97.62%(41/42),高于对照组的80.95%(34/42),差异有统计学意义(P<0.05);治疗后,研究组24 h尿蛋白定量和Scr水平均低于对照组,血清ALB、Ccr水平均高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:他克莫司联合糖皮质激素治疗Ⅱ~Ⅲ期IMN患者可提高治疗总有效率和ALB水平,改善肾功能指标水平,降低24 h尿蛋白定量,效果优于环磷酰胺联合糖皮质激素治疗。

Objective:To observe effects of Tacrolimus combined with Glucocorticoids in treatment of patients with stage Ⅱ~Ⅲ idiopathic membranous nephropathy(IMN).Methods:A prospective study was conducted on 84 patients with stage Ⅱ~Ⅲ IMN admitted to the hospital from June 2019 to September 2022.They were divided into control group and study group by using the odd-even number method,42 cases in each group.The control group was treated with Cyclophosphamide combined with Glucocorticoids,while the study group was treated with Tacrolimus combined with Glucocorticoids.The clinical efficacy,the 24 h proteinuria quantification,the serum total protein(ALB)level and the renal function index[serum creatinine(Scr),endogenous creatinine clearance rate(Ccr)]levels before and after the treatment,and the incidence of adverse reactions during the treatment were compared between the two groups.Results:The total effective rate of the study group was 97.62%(41/42),which was higher than 80.95%(34/42)of the control group,and the difference was statistically significant(P<0.05).After the treatment,the 24 h urinary protein and the Scr level in the study group were lower than those in the control group,the serum ALB and Ccr levels were higher than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Tacrolimus combined with Glucocorticoids in the treatment of the stage Ⅱ~Ⅲ IMN patients can improve the total effective rate of treatment and the ALB levels,improve the levels of renal function indexes,and reduce the 24 h urine protein quantification.Moreover,it is superior to Cyclophosphamide combined with glucocorticoid therapy.