普乐可复治疗Ⅳ型狼疮性肾炎的前瞻性临床研究  

A preliminary study of tacrolimus(FK506) treatment in patients with diffuse proliferative lupus nephritis--A report of 9 cases

作　　者：陈强[1] 刘志红[2] 胡伟新[2] 姚小丹[2] 陈惠萍[2] 陈欣[2] 程震[2] 张波[2] 曾彩虹[2] 黎磊石[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2002年第4期301-307,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :前瞻性观察普乐可复 (FK5 0 6 )治疗Ⅳ型狼疮性肾炎 (LN)的临床疗效及作用特点。　 方法 :9例尿蛋白 >2 0g/2 4h、血尿、肾功能正常的活动性Ⅳ型LN患者 ,均给予FK5 0 6治疗 ,FK5 0 6起始剂量 0 1mg/(kg·d)。同时给予激素 ,7例患者予甲基强的松龙静脉滴注。疗效分为完全缓解 (指尿蛋白 <0 4g/2 4h ,无活动性尿沉渣 ,血清白蛋白 >35g/L ,肾功能正常 ,抗 dsDNA抗体阴性 ) ;无效 (指尿蛋白下降值小于基础值 5 0 % ,血清白蛋白≤ 30g/L ,尿RBC >4 0万 /ml)及部分缓解 (指介于完全缓解与无效之间 )。　 结果 :9例患者FK5 0 6治疗 6～ 12个月 ,无一例退出治疗。 7例获得完全缓解 ,2例部分缓解 ,达到完全缓解的治疗时间 2～ 5 (3 7± 1 1)个月。血清白蛋白水平升高迅速 ,经治疗 1月 ,9例患者中 8例血清白蛋白已升至正常。治疗 3个月和 6个月后分别有 3例、7例患者尿蛋白完全转阴。治疗后 ,血清抗dsDNA抗体及冷球蛋白均降至正常。 6例患者在治疗 6个月时行重复肾活检 ,结果示肾小球细胞性新月体、袢坏死、微血栓、核碎裂消失 ,内皮下大量免疫复合物沉积明显减少。狼疮活动性指数由 10 9± 2 1下降为 3 3± 1 0 (P <0 0 5 )。 4例患者在治疗初期血肌酐可逆性升高 ,2例并发带状疱疹 ,发生高糖血症、?Objective:To investigate the clinical efficacy and side effects of tacrolimus(FK506) in the treatment of patients with diffuse proliferative lupus nephritis(DPLN) Methodology:A preliminary,prospective study was conducted in 9 patients with DPLN(WHO classification type Ⅳ)proven by renal biopsy.The amount of proteinuria of these patients were more than 2 g/24h,accompanied with hematuria.Their renal function were normal.All the patients received the protocol of FK506 combined with steroids.The starting dose of FK506 was 0 1 mg/(kg·d),B.i.d,in accompany with prednisone 0 6 mg/(kg·d).The dose of prednisone was tapered after 4 weeks until a maintenance dose of 10 mg per day.7 of the 9 patients were given methylprednisolone 0 5 g/d intravenously for 3 days at the commencement of treatment.Renal biopsy was repeated after treatment for 6 months.Clinical efficacy was defined as complete remission,partial remission and no response.Complete remission referred to urinary protein less than 0 4 g/24h,no active urinary sediment,serum albumin >35 g/L,renal function was normal and anti dsDNA antibody negative.No response referred to the group showing decrease of urinary protein less than 50% of the baseline value,serum albumin≤30 g/L,urinary RBC>40×10 4/ml.Partial remission referred to those between complete remission and no response. Results:All the 9 patients tolerated well to the treatment regimen of FK506 for 6～12 months.7 got complete remission,2 partial remission.Time to achieve complete remission varied from 2～5(3 7±1 1) months.The serum albumin increased to normal level in 8 of the 9 patients after treatment for 1 month.After 3 and 6 months,urinary protein reduced to normal in 3(33 3%) and 7(77 8%)of the 9 patients respectively.Anti dsDNA antibody and serum cryoglobulin level became normal in all patients after 6 months.Repeated renal biopsy in 6 patients(4 with complete remission,2 with partial remission)demonstrated that there were no more cellular crescents,fibrioid necrosis,microthrombi and

关 键 词：普乐可复 Ⅳ型狼疮性肾炎 LN 疗效 尿蛋白 肌酐 

分 类 号：R593.242[医药卫生—内科学] R969.4[医药卫生—临床医学]