他克莫司与环磷酰胺对特发性膜性肾病患者疗效及性激素水平影响的比较  

Comparison in effects of tacrolimus and cyclophosphamide on efficacy and sex hormone levels in patients with idiopathic membranous nephropathy

作　　者：郭醉爽 王建生[1] 郭明好[2] 张文吉[1] 马东红[2] 张宛哲[1] 孟晶茜[1] 刘云[2] 

机构地区：[1]郑州大学第二附属医院,郑州450000 [2]新乡医学院第一附属医院

出　　处：《山东医药》2016年第46期11-14,共4页Shandong Medical Journal

基　　金：河南省科技发展计划项目(142102310300)

摘　　要：目的：比较他克莫司与环磷酰胺对特发性膜性肾病（IMN）患者的疗效及性激素水平的影响。方法选择以肾病综合征为表现的IMN患者46例，分为他克莫司组28例、对照组18例。他克莫司组给予他克莫司胶囊0．05～0．1 mg／（kg·d），每天分2次空腹服用；醋酸泼尼松片起始剂量0．5 mg／（kg·d）晨起口服，1次／d，8周后减量。对照组给予环磷酰胺0．8 g静脉滴注，每2周1次；同时给予醋酸泼尼松片1．0 mg／（kg·d）晨起口服，1次／d，8周后减量。两组均治疗3个月。治疗前、治疗1个月、治疗3个月时，检测两组24 h尿蛋白定量、血浆白蛋白水平；治疗前及治疗3个月时，检测两组性激素中睾酮（T）、雌二醇（E2）、卵泡刺激素（FSH）、黄体生成素（LH）、泌乳素（PRL）、性激素结合球蛋白（SBG）水平。结果与治疗前相比，他克莫司组治疗1个月时24 h尿蛋白定量减少、血清白蛋白水平增高（P均＜0．05），环磷酰胺组治疗1个月时24 h尿蛋白定量减少（P＜0．05）；两组治疗3个月时24 h尿蛋白定量均减少，血清白蛋白水平均增高（P均＜0．05）。与环磷酰胺组相比，他克莫司组治疗1、3个月时24 h尿蛋白定量减少，血清白蛋白水平增高（P均＜0．05）。与治疗前比较，两组治疗3个月时血清E2、T及SBG水平均下降，FSH及LH水平均升高（P均＜0．05）。治疗3个月时，他克莫司组血清E2、T及SBG水平均高于对照组， FSH水平低于对照组（P均＜0．05）。他克莫司组不良反应发生率低于对照组（P＜0．05）。结论与环磷酰胺方案比较，对临床表现为肾病综合征的IMN患者选用他克莫司方案起效更快、效果更好，且对性激素的抑制作用较小。Objective To investigate the effects of tacrolimus combined with glucocorticoid on the levels of sex hor-mones in patients with idiopathic membranous nephropathy （IMN）.Methods Forty-six IMN patients with the performance of nephrotic syndrome were divided into the tacrolimus group （28 cases）and the control group （18 cases）.The tacrolimus group was given tacrolimus capsules 0.05-0.1 mg/（kg·d）,twice a day on an empty stomach and prednisone acetate tab-lets with starting dose of 0.5 mg/（kg·d）,morning orally,1 time /d,and after 8 weeks we reduced the dose.The control group was treated with 0.8 g cyclophosphamide by intravenous drip,1 time every 2 weeks,together with prednisone 1 mg/（kg·D）morning orally,1 time/d,and after 8 weeks we reduced the dose.These two groups were treated for 3 months. Before treatment,1 and 3 months after treatment,24 h urinary protein quantitative level and serum albumin level were de-tected in the two groups as well as the sex hormone testosterone （T）,estradiol （E2）,follicle stimulating hormone,luteini-zing hormone （FSH）hormone （LH）,prolactin （PRL）and sex hormone binding globulin （SBG）levels.Results Com-pared with that before treatment,24-hour urinary protein quantitative level reduced,the serum albumin level increased the tacrolimus group at 1 month after treatment （all P〈0.05）,and in the cyclophosphamide group at 1 month after treatment,＆amp;nbsp;24-hour urinary protein quantitative level reduced （P〈0.05）.At 3 months after treatment,24-hour urinary protein quanti-tative level decreased and the serum albumin level increased （all P〈0.05）.Compared with the cyclophosphamide group, 24-hour urinary protein quantitative level decreased,and the serum albumin level increased in the tacrolimus group at 1 and 3 months after treatment （all P〈0.05）.At 3 months after treatment,the levels of serum E2,T and SBG were decreased, and the FSH and LH levels were increased as compared with that before treatment （all P〈0.05）.At 3 m

关 键 词：特发性膜性肾病 性激素 他克莫司 环磷酰胺 

分 类 号：R692.9[医药卫生—泌尿科学]