他克莫司联合糖皮质激素治疗特发性膜性肾病的临床效果

他克莫司联合糖皮质激素治疗特发性膜性肾病的临床效果作者：侯终君来源：《中国医药导报》2014年第31期[摘要] 目的观察他克莫司联合糖皮质激素治疗特发性膜性肾病的临床效果。

方法选取辽宁省盘锦市中心医院2011年3月～2013年3月收治入院的特发性膜性肾病患者68例，并将其随机分为治疗组与对照组，各34例。

两组患者均给予泼尼松片mmol/L、（4.01±0.96）mmol/L]比较，差异均有统计学意义（均P < 0.05），且治疗组治疗后尿蛋白、血清白蛋白与对照组比较，差异亦有统计学意义（P < 0.05）。

治疗组中出现2例血肌酐轻度升高，1例血糖升高，1例血压升高，1例腹泻，2例脱发。

对照组中出现3例血肌酐轻度升高，2例腹泻，4例脱发，无高血糖、高血压发生。

两组不良反应发生情况比较，差异无统计学意义（P >0.05）。

结论他克莫司联合糖皮质激素是治疗特发性膜性肾病的有效手段，值得临床推广应用。

[关键词] 他克莫司；糖皮质激素；特发性膜性肾病；效果[中图分类号] R692.3 [文献标识码] A [文章编号] 1673-7210（2014）11（a）-0069-04Clinical effect of Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathyHOU ZhongjunDepartment of Nephrology， Panjin Central Hospital， Liaoning Province， Panjin 124000，China[Abstract] Objective To observe the clinical effect of Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy. Methods 68 cases of patients with idiopathic membranous nephropathy admitted to Panjin Central Hospital from March 2011 to March 2013 were chosen and randomly divided into two groups： treatment group and control group， with 34 cases in each group. The patients of both groups were given Prednisone Tablets 0.5 mg/（kg·d） orally，decreasing to 10 mg/d gradually and keep taking. On this basis， the treatment group was given Tacrolimus， the initial dosage was 0.05-0.10 mg/（kg·d） orally with an empty belly in twice，after treatment for 2 weeks， the drug dosage was adjusted according to plasma concentration， and keep plasma concentration in 5-10 μg/L， the course was 12 months at least. The control group was given intravenous drip of Cyclophosphamide 750 mg/m2， once a month， the maximum dose of every month was not more than 1 g， lasting for 6 months， if it didn't work after treating for 6 months， then stopped taking it. If the symptom got better， using it once every 2 months， the totaldosage couldn't exceed 10 g. The clinical effect of the two groups was observed. The clinical indexes （including urine protein， serum albumin， cholesterol， triacylglycerol， serum creatinine）before and after treatment of the two groups were detected. Results The total effective rate of treatment group （91.18%） was higher than that of control group （76.47%）， the difference was statistically significant （P < 0.05）. The level of urine protein， serum albumin， cholesterol，triacylglycerol after treatment in both groups [treatment group：（0.83±0.05） g/24 h，（42.12±13.38） g/L，（7.34±2.31） mmol/L，（1.03±0.37） mmol/L； control group：（2.47±0.43） g/24 h，（36.22±11.54） g/L，（8.25±3.06） mmol/L，（1.34±0.58） mmol/L] all had statistically significant differences compared with before treatment [treatment group：（6.13±1.35） g/24 h，（23.16±6.41） g/L，（13.56±4.19） mmol/L，（3.51±0.87）mmol/L； control group：（5.69±1.27） g/24 h，（25.27±7.07） g/L，（14.38±4.59）mmol/L，（4.01±0.96） mmol/L] （all P < 0.05）. And there were statistically significant differences of urine protein， serum albumin after treatment between the two groups （P < 0.05）. In the treatment group， there were 2 cases of serum creatinine increasing lightly， 1 case of blood glucose increasing， 1 case of blood pressure increasing， 1 case of diarrhea， 2 cases of baldness. In the control group， there were 3 cases of serum creatinine increasing lightly， 2 cases of diarrhea， 4 cases of baldness， and there were no high blood glucose and high blood pressure. The adverse reactions of the two groups had no statistically significant difference （P > 0.05）. Conclusion Tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy is an effective method， which is worthy of clinical promotion and application.[Key words] Tacrolimus； Glucocorticoids； Idiopathic membranous nephropathy； Effect膜性肾病是引起成人肾病综合征的一种常见病因，依据病因可将其可分为特发性和继发性两种类型[1]。

特发性膜性肾病发病机制尚不明确，多认为是由内源性抗原引起局部或原位免疫复合物形成的自身免疫性疾病[2-3]。

其好发于中老年人，发病年龄为40～50岁。

特发性膜性肾病临床过程多种多样，约20%的成年人可在10年内进展至终末期肾病，约25%的患者可在5年内自发性缓解。

特发性膜性肾病起病隐匿，多数患者发病时没有肾功能损害或损害较轻微。

若进展迅速，如突然发展至急性肾功能不全，则必须考虑其是否存在并发症，如新月体性肾小球肾炎等[4-6]。

特发性膜性肾病目前尚无统一的治疗方案，应根据患者个体病情的不同采取不同的治疗方法。

本研究采用他克莫司联合糖皮质激素治疗特发性膜性肾病，以探讨其临床效果，现将具体结果报道如下：1 资料与方法1.1 一般资料本研究选取辽宁省盘锦市中心医院（以下简称“我院”）2011年3月～2013年3月收治入院并经肾活检确诊的患者68例，所有患者且符合以下纳入标准：①年龄在18～75岁之间，性别不限；②病理分期为Ⅰ～Ⅲ期；③育龄期女性患者妊娠试验结果阴性，并同意采取避孕措施；④肾功能正常，无严重肾病综合征表现。

排除标准：①各种继发性膜性肾病或伴有其他严重肾脏疾病；②伴严重感染、恶性肿瘤、心功能不全、糖代谢异常等严重并发症；③对大环内酯类药物过敏；④肝功能异常患者；⑤依从性差，对本药物过敏者。