特发性膜性肾病患者足突宽度与尿蛋白量和他克莫司治疗反应的关系  

Relationship between the foot process width,urinary protein and the patient's response to tacrolimus in patients with idiopathic membranous nephropathy

作　　者：朱佳佳[1] 马东红[1] 刘云[1] 许清玉[1] 刘向东[1] 张连云[1] 马海军[1] 朱铁锤[1] 杨军[1] 侯玉龙[1] 段峥[1] 周一龙[2] 郭明好[2] 

机构地区：[1]新乡医学院第一附属医院肾病科,河南卫辉453100 [2]新乡医学院第三附属医院肾病科,河南新乡453003

出　　处：《新乡医学院学报》2017年第5期381-384,共4页Journal of Xinxiang Medical University

基　　金：河南省科技发展计划项目(编号:142102310300)

摘　　要：目的观察特发性膜性肾病(IMN)患者足突宽度(FPW)与尿蛋白量(Upro)和他克莫司方案治疗反应的关系。方法选取2015年6月至2016年3月新乡医学院第一附属医院确诊为IMN患者34例,根据患者FPW中位数将患者分为轻度足突融合组(FPW≤2 200 nm)12例和重度足突融合组(FPW>2 200 nm)22例,患者均应用他克莫司方案进行治疗6个月。观察患者FPW与Upro的相关性;不同FPW组患者应用他克莫司治疗后的临床疗效。结果34例IMN患者平均FPW为(2 579.90±994.50)nm,FPW与Upro存在显著正相关(r=0.607,P<0.001)。轻度足突融合组患者平均FPW为(1 776.30±560.20)nm,24 h Upro为(2.10±0.70)g;重度足突融合组患者FPW为(2 914.80±947.90)nm,24 h Upro为(6.50±2.20)g;重度足突融合组患者FPW和24 h Upro均较高于轻度足突融合组(P<0.05)。治疗后,轻度足突融合组患者12例中完全缓解(CR)4例(33.3%),部分缓解(PR)2例(16.7%),无效(NR)6例(50.0%),治疗总缓解率50.0%(6/12);重度足突融合组患者22例中CR 7例(32.4%),PR 12例(41.2%),NR 3例(26.5%),治疗总缓解率86.3%(19/22);重度足突融合组患者治疗总缓解率显著高于轻度足突融合组(χ~2=6.801,P<0.05)。结论足突融合参与尿蛋白的发生,其严重程度决定了Upro的多少;他克莫司对于严重足突融合的患者治疗效果较好,这类患者在治疗方案上应优先选择他克莫司。Objective To observe the correlation between the foot process width （FPW）,urinary protein （Upro）and the treatment response of patients to tacrolimus in patients with idiopathic membranous nephropathy （IMN）.Methods Thirty-four patients with IMN were selected in the First Affiliated Hospital of Xinxiang Medical University from June 2015 to March 2016.The patients were divided into mild foot process fusion group （FPW ≤2 200 nm）（n =12）and severe foot process fusion group （FPW 〉 2 200 nm） （n =22） according to the median of FPW.All patients were treated with tacrolimus for 6 months.The relationship between the FPW and Upro were observed in all patients;the therapeutic effect of patients in mild foot fusion group and severe foot fusion group were observed.Results The average FPW of 34 patients was （2 579.90 ± 994.50） nm.The FPW was positive correlation with Upro （r =0.607,P 〈 0.001）.The average FPW and Upro in 24 h of patients in the mild foot process fusion group was（1 776.30 ± 560.20） nm and （2.10 ± 0.70） g respectively;the average FPW and Upro in 24 h of patients in the severe foot process group was （2 914.80 ± 947.90） nm and （6.50 ± 2.20） g respectively.The average FPW and Upro in 24 h of patients in the severe foot fusion group were significantly higher than those in the mild foot process fusion group （P 〈 0.05）.After treatment,in the mild foot process fusion group,4 patients were complete remission （CR） （33.3 %）,2 patients were partial remission（PR） （16.7%）,6 patients were no response（NR） （50.0%）,the total remission rate was 50.0% （6/12）;in the severe foot process group,7 patients were CR（32.4%）,12 patients were PR（41.2%）,3 patients were NR （26.5%）,the total remission rate was 86.3% （19/22）;the remission rate of patients in the severe foot process fusion group was significantly higher than that in the mild foot process fusion group （x2 =6.801,P 〈 0.05）.Conclusions Foot process fusion participate i

关 键 词：特发性膜性肾病 尿蛋白 足突宽度 他克莫司 

分 类 号：R692[医药卫生—泌尿科学]