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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0.5mg(/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10mg(/kg·d)后维持至1年;MMF750mg,每日2次;FK506起始用量1mg,每日2次(服用1周后查谷浓度,血药浓度维持在4～8ng/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 efficacy and safety of semi-hormones combined with tacrolimus (FK506) in the treatment of idiopathic membranous nephropathy (IMN). Methods: A retrospective study was conducted to select 45 patients with renal biopsy and clinical diagnosis of IMN in our hospital. According to the different treatment methods, the observation group and the control group were divided into two groups. The observation group received half-dose of hormone combined with FK506, while the control group received half-dose of hormone Combined mycophenolate mofetil (MMF). Specific usage: prednisone 0.5mg (/ kg · d), Dayton morning service, continued for 2 to 3 months after the gradual reduction, by 10% every 10 days dose, reduced to 10mg (/ kg · d) After 1 week, the maintenance of the plasma concentration of 4 ~ 8ng / ml, according to the results to adjust the amount of). The follow-up time was 1 year. The levels of albuminuria, serum albumin, total cholesterol and endogenous creatinine clearance were observed. Results: After 1 month of treatment, the urinary protein in the observation group decreased significantly, the serum albumin increased obviously, the total cholesterol decreased obviously, while the control group began to relieve obviously at 3 months, the difference was statistically significant P <0.05). After 12 months of treatment, the remission rate of urinary protein in the observation group was 95.83%, which was higher than that of the control group (80.95%). There was significant difference between the two groups (P <0.05). There was no significant change in endogenous creatinine clearance between the two groups (P> 0.05). Conclusion: The combination of semi-hormones and FK506 in the treatment of IMN is effective.