半量激素联合他克莫司治疗特发性膜性肾病的临床研究

摘要

目的:观察半量激素联合他克莫司(FK506)治疗特发性膜性肾病(IMN)的疗效及安全性.方法:采用回顾性研究方法,选取我院经肾活检并结合临床诊断为IMN的患者45例,根据治疗方法不同分为观察组与对照组,观察组给予半量激素联合FK506,对照组给予半量激素联合霉酚酸酯(MMF).具体用法:泼尼松0.5 mg/(kg·d),清晨顿服,持续2～3个月后逐渐减量,按每10天减10％的药量,减至10 mg/(kg·d)后维持至1年;MMF 750 mg,每日2次;FK506起始用量1 mg,每日2次(服用1周后查谷浓度,血药浓度维持在4～8 ng/ml,根据结果调整用量).随访时间为1年,观察两组蛋白尿水平、血清白蛋白、总胆固醇、内生肌酐清除率等指标变化.结果:在治疗1个月后,观察组尿蛋白定量明显降低、血清白蛋白明显上升、总胆固醇明显降低,而对照组3个月时才开始出现明显缓解,两组比较差异有统计学意义(P＜0.05);治疗12个月,观察组尿蛋白缓解率达到95.83％,高于对照组的80.95％,两组比较差异有统计学意义(P＜0.05).两组内生肌酐清除率无明显变化(P＞0.05).结论:半量激素联合FK506治疗IMN疗效确切.%OBJECTIVE: To observe the clinical efficacy and safety of half-dose hormone combined with tacrolimus (FK506) on idiopathic membranous nephropathy (IMN). METHODS: By retrospective study, 45 patients with biopsy-proven IMN were collected and divided into observation group and control group. Observation group was given half-dose hormone combined with FK506, and control group was given half-dose hormone combined with mycophenolate mofetil (MMF). The medication was as fo Hows: prednisone 0.5 mg/(kg·d )was taken in the early morning, po, qm , reducing gradually after 2-3 months, and reduced to 10 mg/(kg·d )by 10% every 10 days, maintaining for 1 year; MMF 750 mg was taken twice a day; FK506 was also taken twice a day with initial dose of 1 mg (testing trough concentration after a week, blood concentration maintaining 4-8 ng/ml, drug dosage adjusted according to results). Follow-up time was 1 year. Changes of proteinuria, serum albumin, total cholesterol, endogenous creatinine clearance, were observed in 2 groups. RESULTS: After 1 month of treatment, urine protein quantitative and total cholesterol significantly reduced, while serum protein increased significantly in observation group; the index of control group began to relieve at 3 months; there was statistical significance between 2 groups (P<0.05). After 12 months of treatment, remission rate of proteinuria in observation group reached 95.83% , which was higher than 80.95% of control group, there was statistical significance between 2 groups (P<0.05). No significant change of endogenous creatinine clearance rate was found in 2 groups (P> 0.05). CONCLUSIONS: Half-dose hormone combined with FK506 has positive effects on IMN.