他克莫司对特发性膜性肾病疗效的影响因素分析  

Analysis of clinical and pathological factors affecting the effect of tacrolimus on idiopathic membranous nephropathy

作　　者：李文婷 张蓓茹[1] 边晓慧[1] 于锐[1] 张永哲 赵自霞[1] LI Wen-ting;ZHANG Bei-ru;BIAN Xiao-hui;YU Rui;ZHANG Yong-zhe;ZHAO Zi-xia(Department of Nephrology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院肾内科,沈阳110004

出　　处：《实用药物与临床》2018年第11期1256-1260,共5页Practical Pharmacy and Clinical Remedies

基　　金：辽宁省自然科学基金(2015020490)

摘　　要：目的探讨影响特发性膜性肾病患者应用他克莫司治疗效果的临床与病理因素。方法回顾分析我院肾内科病房2011年11月至2017年10月经过肾穿刺活检明确特发性膜性肾病诊断、应用他克莫司联合激素治疗且用药后门诊或住院规律随访至少半年的43例患者的临床及病理资料,根据患者的治疗效果分为无效组和有效组。采用独立样本t检验、卡方检验、多因素Logistic二元逐步回归分析等统计学方法分析影响他克莫司治疗效果的临床与病理因素。结果共纳入43例患者,男33例,女10例,有效组14例,无效组29例。无效组患者年龄较大(χ~2=12. 444,P=0. 002),且合并高血压比例较高(χ~2=7. 525,P=0. 006)。多因素Logistic二元逐步回归分析显示,初始治疗时患高血压(β=1. 968,OR=7. 159,95%CI 1. 159～44. 215,P=0. 034)是影响特发性膜性肾病患者他克莫司治疗反应的独立危险因素。结论患者初治时合并高血压是特发性膜性肾病患者应用他克莫司治疗效果不佳的主要危险因素,在临床治疗时应进行相关干预。Objective To investigate the clinical and pathological factors which affect the effect of tacrolimus on idiopathic membranous nephropathy. Methods Totally 43 patients who were diagnosed with idiopathic membranous nephropathy by renal biopsy and followed-up for at least six months in the department of nephrology of our hospital from November 2011 to October 2017 were retrospectively analyzed,and their clinical and pathological data were collected. All the patients were treated with tacrolimus combined with glucocorticoid. They were divided into invalid group and effective group according to the patient＇ s therapeutic effect. The independent samples t-test,chi-square test and multivariate logistic binary stepwise regression analysis were used to analyze the clinical and pathological factors which could influence the effect of tacrolimus treatment. Results Forty-three patients were enrolled in the study,including 33 men and 10 women. There were 14 cases in effective group and 29 cases in invalid group. It was shown that patients in invalid group were older than those in effective group（ χ~2= 12. 444,P = 0. 002）,and the proportion of patients with hypertension in invalid group was higher（ χ~2= 7. 525,P = 0. 006）. Further multivariate Logistic two stepwise regression analysis showed that hypertension history at initial treatment was an independent risk factor for tacrolimus treatment response in patients with idiopathic membranous nephropathy（ β = 1. 968,OR = 7. 159,95% CI： 1. 159 ～44. 215,P = 0. 034）. Conclusion Hypertension at initial treatment is a major risk factor for poor response to tacrolimus in patients with idiopathic membranous nephropathy and should be intervened in clinical practice.

关 键 词：特发性膜性肾病 他克莫司 影响因素 预后 

分 类 号：R692[医药卫生—泌尿科学]