小剂量激素联合他克莫司对局灶节段性肾小球硬化并发早期肾衰竭疗效研究

Effect of Small Dose of Hormone Combined with Tacrolimus Capsules on Focal Segmental Glomerulosclerosis Complicated with Early Renal Failure

目的观察小剂量激素联合他克莫司对局灶节段性肾小球硬化(FSGS)并发早期肾功能衰竭的蛋白尿、血肌酐(SCr)、内生肌酐清除率(Ccr)的疗效。方法将100例已足量应用醋酸泼尼松治疗4个月无效者判断为激素抵抗、将激素减量至15~20 mg/d的患者纳入研究,依据纳入顺序单双号随机分为他克莫司组和环孢素组,各50例。他克莫司组在小剂量激素维持治疗基础上给予他克莫司胶囊,环孢素组在小剂量激素维持治疗基础上给予环孢素,均连续治疗12个月。结果治疗后,两组患者24 h尿蛋白定量(U-TP)和SCr均下降,但他克莫司组降速大于环孢素组,两组U-TP水平从第2周、SCr水平第4周开始有统计学差异(P<0.05),而两组Ccr水平相对维持稳定,但均缓慢下降,第48周时他克莫司组Ccr水平显著高于环孢素组(P<0.05)。结论小剂量激素联合他克莫司能有效减慢局灶节段性肾小球硬化并发早期肾功能衰竭时肾功能损害的进展,值得临床应用。

Objective To observe the effect of small dose of hormone combined with Tacrolimus Capsules on urine protein, serum creati-nine, endogenous creatinine scavenging rates of focal segmental glomerulosclerosis ( FSGS ) complicated with early renal failure. Methods 100 cases of patients who were treated with prednisone for 4 months treatment and been judged as hormone resistance, and the hormone reduction to 15 ~20 mg/d were enrolled into the study. They were randomly divided into tacrolimus and cyclosporine group with 50 cases in each group according to the single and double order. Tacrolimus group was given Tacrolimus Capsules maintained in small dose of hormone therapy, and cyclosporine group was given low dose of cyclosporine hormone on maintain treatment, both for 12 months of continuous treatment. Results At the start of treatment, U-TP, SCr of the two groups were decreased, but the tacrolimus group fall velocity was larger than the cyclosporine group, U-TP levels in the two groups had significant difference from second weeks and the SCr from fourth weeks ( P < 0. 05 ) , and Ccr levels in the two groups remained relatively stable, but slowly decline, the Ccr level of the tacrolimus group was significantly higher than that of CSA group at 48 weeks, with significant difference ( P < 0. 05 ) . Conclusion Small dose of hormone combined with Tacrolimus Capsules can effectively slow down the advances of renal impairment of patients with focal segmental glomerulosclerosis complicated with early renal failure, which deserves clinical application.