他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效及对血清PLA2R抗体、Kim-1水平的影响  

Efficacy of tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy and its effect on serum PLA2R antibody and Kim-1 levels

作　　者：夏林 黄秋萍 曹秋夏 曾欢 XIA Lin;HUANG Qiu-ping;CAO Qiu-xia(Department of Nephrology,Neijiang First People's Hospital,Neijiang Sichuan 641000,China)

机构地区：[1]内江市第一人民医院肾内科,四川内江641000

出　　处：《临床和实验医学杂志》2023年第2期158-161,共4页Journal of Clinical and Experimental Medicine

基　　金：四川省卫生和计划生育委员会科研课题(编号:17PJ081)。

摘　　要：目的研究他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效及对血清抗M型磷脂酶A2受体(PLA2R)抗体、肾损伤分子-1(Kim-1)水平的影响。方法回顾性选取2019年1月至2022年3月内江市第一人民医院收治的60例特发性膜性肾病患者作为研究对象,根据患者治疗方案不同分为实验组(n=30)和对照组(n=30)。对照组给予常规环磷酰胺联合糖皮质激素治疗,实验组则给予他克莫司联合糖皮质激素治疗,治疗持续6个月。记录两组患者临床疗效,比较两组患者治疗前后血清PLA2R抗体、Kim-1、尿蛋白、总胆固醇、白蛋白,并比较两组患者治疗期间不良反应发生情况。结果实验组治疗后的总有效率为93.33%,较对照组的73.33%显著更高,差异有统计学意义(P<0.05)。治疗后,两组患者的PLA2R抗体和Kim-1水平较治疗前显著降低,且实验组PLA2R抗体和Kim-1水平为(3.11±0.57)μg/mL、(3.21±0.76)ng/mL,较对照组[(4.41±0.66)μg/mL、(4.68±0.81)ng/mL]显著更低,差异均有统计学意义(P<0.05)。治疗6个月后,两组患者的尿蛋白和总胆固醇水平较治疗前显著降低,白蛋白较治疗前显著升高,且实验组尿蛋白和总胆固醇水平为(0.43±0.11)μg/mL、(5.19±0.78)ng/mL,较对照组[(0.82±0.14)μg/mL、(6.23±0.81)ng/mL]显著更低,白蛋白为(36.79±1.44)g/24 h,较对照组[(30.77±1.62)g/24 h]显著更高,差异均有统计学意义(P<0.05)。两组患者治疗期间均未发生严重的不良反应。结论与环磷酰胺联合糖皮质激素治疗比较,他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效较高,同时可有效降低血清PLA2R抗体、Kim-1水平。Objective To study the clinical efficacy of tacrolimus combined with glucocorticoids in the treatment of idiopathic membranous nephropathy,and to study its effect on serum phospholipase A2 receptor(PLA2R)antibody and kidney injury molecule-1(Kim-1)levels.Methods Sixty patients with idiopathic membranous nephropathy in Neijiang First People’s Hospital from March 2019 to March 2022 were retrospectively enrolled,and classified into two groups according to different treatment methods,each with 30 cases.The control group was given cyclophosphamide combined with glucocorticoid,while the experimental group was given tacrolimus combined with glucocorticoid.Treatment in both groups lasted for 6 months.Then comparison was conducted on clinical efficacy,serum levels of PLA2R antibody,Kim-1,urine protein,total cholesterol and albumin and the adverse reaction rate.Results The clinical efficacy rate was 93.33%in experimental group,which was higher than(73.33%)in control group,the difference was statistically significant(P<0.05).After treatment,serum levels of PLA2R antibody and Kim-1 were notably decreased in both groups,and the two indicators of experimental group were(3.11±0.57)μg/mL,(3.21±0.76)ng/mL,which were lower than those of control group[(4.41±0.66)μg/mL,(4.68±0.81)ng/mL],the differences were statistically significant(P<0.05).After 6 months of treatment,the levels of urine protein and total cholesterol in the two groups were significantly lower than those before treatment,and the levels of albumin were significantly higher than those before treatment,and the levels of urine protein and total cholesterol in the experimental group were(0.43±0.11)μg/mL,(5.19±0.78)ng/mL,which were significantly lower than those in the control group[(0.82±0.14)μg/mL,(6.23±0.81)ng/mL],albumin was(36.79±1.44)g/24 h,which was significantly higher than that in the control group[(30.77±1.62)g/24 h],and the differences were statistically significant(P<0.05).No serious adverse effects occurred during treatment in either group.Conc

关 键 词：他克莫司 糖皮质激素 特发性膜性肾病 PLA2R抗体 KIM-1 

分 类 号：R692[医药卫生—泌尿科学]