他克莫司联合糖皮质激素对难治性肾病综合征患者肝肾功能、糖脂代谢及不良反应的影响  

Effects of Tacrolimus combined with Glucocorticoids on Liver and Kidney Function,Glucolipid Metabolism and Adverse Reactions in Patients with Refractory Nephrotic Syndrome

作　　者：王莉[1] 金明 黄俊波 刘杰[1] 许美娟 WANG Li;JIN Ming;HUANG Jun-bo;LIU Jie;XU Mei-juan(Department of Nephrology,the First People's Hospital of Xiantao,Xiantao,Hubei 433000,China)

机构地区：[1]仙桃市第一人民医院肾病内科,湖北仙桃433000

出　　处：《解放军医药杂志》2019年第2期90-93,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：湖北省自然科学基金项目(2014CFC1233)

摘　　要：目的观察他克莫司(FK506)联合糖皮质激素(GC)治疗对难治性肾病综合征(RNS)患者的肝肾功能、糖脂代谢和不良反应的影响。方法选取2015年9月—2017年9月仙桃市第一人民医院RNS患者66例,按治疗方法分为观察组和对照组,每组33例,对照组采用环磷酰胺+GC;观察组采用FK506+GC。于治疗前及治疗6个月后检测2组肝、肾功能、糖脂代谢及尿肾损伤标志物水平,观察并记录药物不良反应情况。结果 2组治疗前、治疗6个月后丙氨酸氨基转移酶、天冬门氨酸转移酶、空腹血糖组间及组内比较差异均无统计学意义(P> 0. 05)。2组治疗后24 h尿蛋白定量、肌酐、尿素氮、甘油三酯、胆固醇均低于治疗前,且观察组低于对照组(P <0. 05)。2组治疗后尿视黄醇结合蛋白、肾损伤分子-1、N-乙酰-β-D葡萄糖酐酶水平均低于治疗前,且观察组低于对照组(P <0. 05)。2组不良反应发生率比较差异无统计学意义(P> 0. 05)。结论 FK506联合GC治疗RNS可改善患者肾功能和血脂代谢状态,减轻肾损伤,对肝功能无显著影响,不良反应少,有利于控制疾病进展、促进患者恢复。Objective To observe effects of Tacrolimus(FK506)combined with glucocorticoids(GC)on liver and kidney function,glucolipid metabolism and adverse reactions in patients with refractory nephrotic syndrome(RNS).Methods A total of 66 RNS patients admitted during September 2015 and September 2017 were divided into observation group and control group(n=33 for each group)according to therapeutic methods.Control group was treated with Cyclophosphamide+GC,while observation group was treated with FK506+GC.In two groups,levels of liver function,renal function indexes,glucolipid metabolism and urinary and renal injury markers were detected before and after treatment for 6 months,and conditions of adverse drug reactions were observed.Results There were no significant differences in levels of alanine aminotransferase,aspartate aminotransferase and fasting blood glucose before and after treatment for 6 months between two groups(P >0.05).After treatment,levels of 24 h urinary protein quantitation,creatinine,urea nitrogen,triglyceride and cholesterol were significantly lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05);levels of urinary retinol binding protein,renal injury molecule-1 and N-acetyl-β-D glucuronidase were lower than those before treatment in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in incidence rate of adverse reactions between two groups(P >0.05).Conclusion Tacrolimus combined with GC in treatment of patients with refractory nephrotic syndrome may improve renal function and blood lipid metabolism and reduce renal injury,and it has no significant effect on liver function with few adverse reactions,and therefore it is helpful to control progression of disease and promote recovery of patients.

关 键 词：肾病综合征 他克莫司 糖皮质激素 肝肾功能 药物毒性 

分 类 号：R692[医药卫生—泌尿科学]