他克莫司联合小剂量激素治疗中老年IMN的疗效与安全性研究  

Study on the Efficacy and Safety of Tacrolimus Combined with Low-dose Hormone in the Treatment of Middle-aged and Elderly Patients with IMN

作　　者：罗子云 LUO Zi-yun(Nephrology Department of Yichun People’s Hospital;The Affiliated Hospital of Yichun University,Yichun 336000,China)

机构地区：[1]宜春市人民医院肾内科 [2]宜春学院附属医院,江西宜春336000

出　　处：《宜春学院学报》2023年第3期61-63,78,共4页Journal of Yichun University

基　　金：宜春市科技计划项目(编号:JXYC2021KSA002)。

摘　　要：目的:研究他克莫司联合小剂量激素治疗中老年特发性膜性肾病(Idiopathic membranous nephropathy, IMN)的疗效与安全性。方法:选择2019年9月-2022年9月在我院诊治的60例IMN病患,按照随机数字表法将其随机分为两组,各30例。两组均给予肾内科常规对症治疗,对照组采用护肾、降蛋白尿治疗,于对照组基础上,观察组采用醋酸泼尼松片、他克莫司胶囊治疗。比较两组临床疗效、实验室指标[血浆总蛋白(Total plasma protein, TP)、白蛋白(Albumin, ALB)、24h尿蛋白定量(24-hour urine protein quantification, 24hpro)、血肌酐(creatinine, Cr)、血尿素氮(Blood urea nitrogen, BUN)、尿酸(Uric acid, UA)、谷丙转氨酶(Alanine aminotransferase, ALT)、谷草转氨酶(Aspartate aminotransferase, AST)]及不良反应。结果:观察组对比对照组总缓解率高,治疗后观察组TP、ALB高于对照组,24hpro低于对照组,有统计学差异(P<0.05);两组治疗前、后的ALT、AST、Cr、BUN及UA、不良反应总发生率比较,无统计学差异(P>0.05)。结论:他克莫司与泼尼松联合治疗中老年IMN可恢复TP、ALB水平,降低24hpro水平,总缓解率高,临床应用安全性高。Objective:To study the efficacy and safety of tacrolimus combined with low-dose hormone in the treatment of elderly idiopathic membranous nephropathy(IMN).Methods:60 patients with IMN diagnosed and treated in our hospital from September 2019 to September 2022 were randomly divided into two groups according to the random number table method,30 patients in each group.Both groups were given routine symptomatic treatment in nephrology department.The control group was treated with kidney protection and proteinuria reduction.On the basis of the control group,the observation group was treated with prednisone acetate tablets and tacrolimus capsules.The clinical efficacy,laboratory indexes[total plasma protein(TP),albumin(ALB),24-hour urine protein quantification(24hpro),serum creatinine(Cr),blood urea nitrogen(BUN),uric acid(UA),alanine aminotransferase(ALT),aspartate aminotransferase(AST)]and adverse reactions were compared between the two groups.Results:The total remission rate in the observation group was higher than that in the control group.After treatment,TP and ALB in the observation group were higher than that in the control group,and 24hpro was lower than that in the control group,with statistical difference(P<0.05);There was no significant difference in the total incidence of ALT,AST,Cr,BUN,UA and adverse reactions between the two groups before and after treatment(P>0.05)[HJ1.95mm].Conclusion:Tacrolimus combined with prednisone in the treatment of middle-aged and elderly IMN can restore the level of TP and ALB,reduce the level of 24hpro,with a high overall remission rate and high clinical safety.

关 键 词：中老年特发性膜性肾病 他克莫司 泼尼松 24H尿蛋白定量 白蛋白 

分 类 号：R692[医药卫生—泌尿科学]