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指标与肾功能的影响  

Efficacy of tacrolimus combined with glucocorticoid in the treatment of idiopathic membranous nephropathy and its influence on serum indicators and renal function

作　　者：高真真[1] 王秀莲 耿明亮[1] 段海玲[1] GAO Zhen-zhen;WANG Xiu-lian;GENG Ming-liang(Department of Nephrology,Binzhou Central Hospital,Binzhou 251700,China)

机构地区：[1]滨州市中心医院肾内科,251700

出　　处：《中国实用医药》2024年第19期116-119,共4页China Practical Medicine

摘　　要：目的探讨他克莫司联合糖皮质激素治疗特发性膜性肾病(IMN)的疗效及对血清指标与肾功能的影响。方法86例IMN患者,随机分为对照组和观察组,每组43例。对照组单用糖皮质激素治疗,观察组使用他克莫司联合糖皮质激素治疗。比较两组的临床疗效、肾功能指标[24 h尿蛋白定量(UP)、血肌酐(Scr)、白蛋白(ALB)、估算肾小球滤过率(eGFR)]、炎性因子及抗体[C反应蛋白(CRP)、抗M型磷脂酶A_2受体(PLA_2R)抗体]、不良反应发生情况。结果观察组治疗3、6个月的总有效率分别为72.09%、81.40%,明显高于对照组的34.88%、41.86%(P<0.05)。观察组治疗1、3、6个月的24 h UP、Scr明显低于对照组,ALB、eGFR明显高于对照组(P<0.05)。观察组治疗6个月后PLA_2R抗体、CRP水平分别为(11.03±2.01)RU/ml、(2.11±0.68)mg/L,均低于对照组的(14.08±3.02)RU/ml、(5.27±1.15)mg/L(P<0.05)。观察组不良反应发生率与对照组比较无明显差异(P>0.05)。结论他克莫司联合糖皮质激素治疗IMN的疗效显著,能有效改善肾功能,减轻炎症反应,降低PLA_2R抗体水平,具有较好的疗效及安全性。Objective To explore the efficacy of tacrolimus combined with glucocorticoid in the treatment of idiopathic membranous nephropathy(IMN)and its influence on serum indicators and renal function.Methods 86 patients with IMN were randomly divided into a control group and an observation group,with 43 cases in each group.The control group was treated with glucocorticoid alone,and the observation group was treated with tacrolimus combined with glucocorticoid.Both groups were compared in terms of clinical efficacy,renal function indicators[24 h urinary protein quantification(UP),serum creatinine(Scr),albumin(ALB),estimated glomerular filtration rate(eGFR)],inflammatory factors and antibodies[C-reactive protein(CRP),M-type phospholipase A2 receptor(PLA2R)antibody]and the occurrence of adverse reactions.Results The total effective rates of the observation group were 72.09%and 81.40%after 3 and 6 months of treatment,which were significantly higher than 34.88%and 41.86%of the control group(P<0.05).After 1,3 and 6 months of treatment,the 24 h UP and Scr of the observation group were significantly lower than those of the control group,and the ALB and eGFR were significantly higher than those of the control group(P<0.05).After 6 months of treatment,the PLA2R antibody and CRP levels in the observation group were(11.03±2.01)RU/ml and(2.11±0.68)mg/L,which were lower than(14.08±3.02)RU/ml and(5.27±1.15)mg/L in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group and the control group(P>0.05).Conclusion Tacrolimus combined with glucocorticoid has a significant effect in the treatment of IMN,which can effectively improve renal function,reduce inflammation and reduce PLA2R antibody level,and has good efficacy and safety.

关 键 词：特发性膜性肾病 他克莫司 糖皮质激素 血清指标 肾功能 

分 类 号：R692[医药卫生—泌尿科学]