24个月他克莫司联合激素治疗特发性膜性肾病26例的疗效和安全性  

Effectiveness and safety of 24 months＇ trealment with tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy

作　　者：吴艳英[1] 姜涛[2] 于宏宇[1] 卢雪红[1] 孙晶[1] 罗萍[1] 刘声茂[1] 苗里宁[1] 

机构地区：[1]吉林大学第二医院肾病内科,长春130041 [2]大连医科大学附属大连市友谊医院泌尿外二科

出　　处：《国际移植与血液净化杂志》2013年第4期33-36,共4页International Journal of Transplantation and Hemopurification

摘　　要：【摘要】目的观察长疗程他克莫司治疗特发性膜性。肾病的疗效和安全性。方法入选2004年3月至2008年6月吉林大学第二医院收治的表现为肾病综合征的特发性膜性。肾病患者26例，其中男18例，女8例，年龄18～72岁，平均（52±18）岁。采用他克莫司联合激素治疗24个月，观察疗效、他克莫司浓度变化及复发情况，通过重复肾活检观察肾脏病理变化。采用t检验或卡方检验进行数据统计。结果经过24个月治疗，18例患者获得完全缓解，4例获得部分缓解，4例无效，1例部分缓解患者复发。他克莫司浓度在初始6个月内波动于4—7μg／L，7至12个月时保持在2．1-4．1μg/L.治疗24个月较治疗前肾脏病理改变明显好转，未见。肾间质纤维化。结论24个月他克莫司联合激素治疗特发性膜性。肾病可明显缓解病情，复发率低，肾脏病理损害明显改善，未见与药物相关的严重不良反应。Objective To evaluate the effect and safety of prolonged use of tacrolimus combined with corticosteroids in treating patients with idiopathic membranous nephropathy （IMN）. Methods Twenty- six consecutive IMN patients （male 18, female 8, age 18-72 years old, mean age （52 ＋ 18） years old） who were diagnosed in our department during March 2004 and June 2008 were recruited in this prospective observation. Tacrolimus in combination with corticosteroids were used for 24 months. Remission, relapse as well as the trough level of tacrohmus were observed. Student＇ s t test or Chi-square test was used for data analysis. Results After treatment for 24 months, 18 and 4 patients achieved complete or partial remission, respectively, and another 4 patients was ineffective. During the first 6 month, the trough level of tacrolimus in most patients fell into the range of 5-7μg/L. During the second 6 months, the trough level of tacrolimus ranged between 2.1 and 4.1μg/L. After withdrawal of corticosteroids and tacrolimus, only 1 part remission patient relapsed. Two patients received repeat renal biopsy, which suggested improvement in renal histology, and renal interstitial fibrosis was not observed. Conclusions Prolonged use （up to 24 months） of cortieosteroids in combination with tacrolimus, even at a low dose, could effectively and safely induce remission, and thereafter reduce relapses of IMN. This regimen might even improve the lesion in renal histology.

关 键 词：肾病综合征 特发性膜性肾病 他克莫司 

分 类 号：R692.3[医药卫生—泌尿科学]