他克莫司联合糖皮质激素治疗成人难治性肾病综合征的临床效果  

Clinical effect of tacrolimus combined with glucocorticoid in the treatment of refractory nephrotic syndrome in adults

作　　者：李美兰 LI Meilan(Department of Nephrology,Anyue County People's Hospital,Sichuan Province,Anyue County 642350,China)

机构地区：[1]四川省安岳县人民医院肾内科,642350

出　　处：《临床合理用药杂志》2021年第28期25-27,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察他克莫司联合糖皮质激素治疗成人难治性肾病综合征的临床效果。方法选择2017年6月-2019年6月四川省安岳县人民医院收治的成人难治性肾病综合征患者64例,采用随机数字表法分为观察组和对照组,每组32例。观察组应用他克莫司联合糖皮质激素治疗,对照组应用环磷酰胺联合糖皮质激素治疗。比较2组治疗效果、治疗前后肾功能指标[血清肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量]、血脂指标[总胆固醇(TC)、三酰甘油(TG)]、肾损伤标志物[尿视黄醇结合蛋白(RBP)、肾损伤分子-1(KIM-1)]及不良反应。结果治疗6个月后,观察组总有效率为93.75%,高于对照组的68.75%(χ^(2)=6.565,P=0.010);治疗6个月后,2组SCr、BUN、24 h尿蛋白定量、TC、TG及RBP、KIM-1水平低于治疗前,且观察组低于对照组(P均<0.01);观察组不良反应总发生率为9.38%,低于对照组的31.25%(χ^(2)=4.730,P=0.030)。结论他克莫司联合糖皮质激素治疗成人难治性肾病综合征患者的效果较好,可有效减轻肾损伤,改善肾功能,调节血脂,且安全性较好。Objective To observe the clinical effect of tacrolimus combined with glucocorticoids in the treatment of refractory nephrotic syndrome in adults.Methods 64 cases of adult patients with refractory nephrotic syndrome admitted to Anyue County People′s Hospital,Sichuan Province from June 2017 to June 2019 were selected.Using random number table method,they were divided into observation group and control group,with 32 cases in each group.The observation group was treated with tacrolimus combined with glucocorticoids,and the control group was treated with cyclophosphamide combined with glucocorticoids.Compared the treatment effects,renal function indexes[serum creatinine(SCr),blood urea nitrogen(BUN),24-hour urine protein quantification],blood lipid indexes[total cholesterol(TC),triacylglycerol(TG)],renal injury markers[urinary retinol binding protein(RBP),kidney injury molecule-1(KIM-1)]and adverse reactions of the two groups.Results After 6 months of treatment,the total effective rate of the observation group was 93.75%,which was higher than 68.75%of the control group(χ^(2)=6.565,P=0.010);After 6 months of treatment,the levels of SCr,BUN,24-hour urine protein quantification,TC,TG,RBP and KIM-1 in the two groups were lower than before treatment,and the observation group was lower than the control group(Pall<0.01);The total incidence of adverse reactions in the observation group was 9.38%,which was lower than 31.25%in the control group(χ^(2)=4.730,P=0.030).Conclusion Tacrolimus combined with glucocorticoids is effective in treating patients with refractory nephrotic syndrome in adults,it can effectively reduce kidney damage,improve kidney function,regulate blood lipids,and has good safety.

关 键 词：难治性肾病综合征 他克莫司 糖皮质激素 肾功能 肾损伤标志物 

分 类 号：R692[医药卫生—泌尿科学]