他克莫司联合小剂量激素治疗成人激素依赖或激素抵抗微小病变肾病的疗效

摘要

目的 观察不同疗程中他克莫司治疗成人激素依赖或激素抵抗微小病变肾病的疗效和复发率.方法 2007年5月至2010年2月我院收治经皮肾活检诊断微小病变肾病,经糖皮质激素规律治疗表现为激素依赖或激素抵抗的26例病例,随机分为短疗程组12例和长疗程组14例.短疗程组给予他克莫司联合口服泼尼松治疗6个月,长疗程组治疗18个月,前6个月治疗同短疗程组,此后单用小剂量他克莫司维持,观察两组的疗效及复发等情况.结果 短疗程组全部完成实验,治疗6个月后9例完全缓解,2例部分缓解,1例无效;治疗期间他克莫司的平均血药浓度保持在4～8 μg/L;治疗过程中及观察结束时,6例复发.长疗程组治疗18个月后,9例获得完全缓解,2例获得部分缓解,1例无效,2例因严重不良反应退出研究,长疗程组他克莫司的浓度在6个月内波动于5～8 μg/L,疗程结束时,2例复发.结论 他克莫司是有效的诱导缓解药物,小剂量他克莫司维持治疗可以有效降低复发率.%Objective To observe the efficacy and relapse-rate of tacrolimus on adults with steroid-dependent or steroid-resistant minimal change disease in different courses of treatment. Methods Twenty-six adult patients with steroid-dependent or steroid-resistant minimal change disease were divided into short-term( 12 cases )and long-term( 14 cases )groups randomly. The patients of short-term group and long-term group were treated with tacrolimus and predni-sone for 6 months and 18 months respectively, then the efficacy, relapses-rate of tacrolimus of the two groups was observed. Results All of the patients in the short-term group completed the study, 9 patients obtained complete remission after 6 months ;2 patients obtained partial remission;1 patient had no response. Average concentration of tacrolimus remained 4 ~ 8 jJtg/L in the period of treatment, and 6 cases recurred. 9 patients obtained complete remission and 2 patients obtained partial remission afterl8 months in the long-term group ;1 patient had no response. 2 patients signed out the study because of serious side effects. Concentration of tacrolimus in the long-term group remained the same as the short-term group at 5 ~ 8 jJig/L at 6 months; 2 cases recurred in long-term group, the relapse-rate was significantly lower than that of short-term group. Conclusion Tacrolimus is a effective treatment for adults with steroid-dependent or steroid-resistant minimal change disease;Low concentration of tacrolimus can reduce recurrence rate.