多靶点治疗难治性特发性膜性肾病的前瞻性研究  

Efficacy of multitarget therapy with refractory idiopathic membranous nephropathy

作　　者：李莉[1] 郭园园[1] 苟蓉[1] 李秋红[1] 杨自君[1] 王刘伟[1] 唐琳[1] 

机构地区：[1]郑州大学第一附属医院肾内科,河南郑州450052

出　　处：《河南医学研究》2017年第11期1933-1936,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划项目(20151010)

摘　　要：目的特发性膜性肾病(IMN)是成人原发性肾病综合征的常见原因。本研究主要是观察多靶点治疗方案对难治性IMN的疗效及安全性。方法将符合标准的45例难治性IMN患者随机分组,其中多靶点治疗组23例,环磷酰胺(CTX)组22例。多靶点治疗组:他克莫司(FK506)起始量为0.05 mg/(kg·d),24 h血药谷浓度维持在3~6 ng/ml,吗替麦考酚酯(MMF)起始量为1.0 g/d;CTX对照组:CTX 100 mg/d,口服3个月(总剂量9 g)。糖皮质激素:强的松0.5 mg/(kg·d),8周后根据复查指标调整剂量。观察两组治疗前后24 h尿蛋白定量、血清白蛋白和血肌酐等疗效指标及不良反应。结果治疗6个月后,多靶点组缓解(完全缓解+部分缓解)率为75%(15例),CTX组缓解率为40%(8例),两组缓解率差异有统计学意义(P=0.013)。在治疗过程中两组患者未见严重不良反应。结论多靶点治疗在难治性IMN患者中安全有效,但其长期疗效及复发率尚需进一步研究观察。Objective Idiopathic membranous nephropathy （IMN） is a common cause of nephrotic syndrome （NS） in adults. This study was performed to observe the efficacy and side - effects of multitarget therapy in treating patients with refractory IMN. Methods Forty five patients with refractory idiopathic membranous nephropathy were recruited in this randomized controlled trial, 23 receiving multitarget therapy, including tacrolimus （Tac）, mycophenolate mofetil （MMF） and low - dose steroids, while 22 receiving cyelophosphamide （CYC） and prednisone. The initial dose of Tac was0. 05 mg/（ kg · d） combined with 1.0 g/d MMF, and the 24 - hour through blood concentration （ CO ） of Tac was approximately 3 - 6 ng/ml. The CYC group received daily oral CYC 100 mg/d for 3 months （accumulated dosage was 9 g ）. Both groups received oral prednisone 0. 5 mg/（kg · d） for 8 weeks and tapered gradually. Results Of the 40 patients who completed the 6 - months treatment, thep- robability of overall remission （CR and PR） was significantly higher in the multitarget group（75% ） than in the CYC group （40%） （P = O. O13 ）. Furthermore, a significantly greater improvement in proteinuria was observed in the multitarget group compared with the CYC group. No obvious nephrotoxicity and other serious side - effects were found in the multitarget group. Conclusion In this trial, lowdose steroids combined with Tac and MMF are effective and safe in refractory IMN. The treatment of refractory cases with muhitarget therapy is promising.

关 键 词：特发性膜性肾病 多靶点治疗 他克莫司 吗替麦考酚酯 

分 类 号：R692[医药卫生—泌尿科学]