小剂量他克莫司治疗难治性狼疮肾炎的临床观察

发布时间：2018-05-04 08:58

本文选题：难治性狼疮性肾炎 + 他克莫司　；参考：《中南大学》2014年硕士论文

【摘要】：目的：探讨他克莫司对难治性狼疮肾炎(LN)的疗效及安全性。方法：将16例难治性LN患者随机分为FK506组和FK506+CTX的多靶点治疗组,FK506剂量均为2mg/d,分早晚两次口服,CTX0.6-1.2g/m。前瞻性随访24周,观察两组病例尿蛋白/肌酐比值(Up/cr)、血尿常规、肝肾功能、不良反应及复发情况,比较两组临床疗效及安全性。根据Up/cr、血清白蛋白等指标将疗效分为完全缓解(CR)、部分缓解(PR)及无效(NR)。结果：治疗24周时FK506组(2例提前退出,共完成6例)总有效率为66.7%(包括1例CR和3例PR),多靶点治疗组(完成8例)总有效率50.0%(包括4例PR),两组总有效率、CR及PR相当(P=0.627,P=0.429,P=1.00)。两组治疗后Up/cr均较治疗前明显下降。多靶点治疗组血清白蛋白较治疗前升高,SLEDAI积分、抗dsDNA降低。两组各有5例和6例病例出现不良事件。其中FK506组有2例病例因严重肾功能不全分别在治疗6周和8周后停药；多靶点治疗组有4例出现胃肠反应,高于FK506组(P=0.038)。两组总的不良事件发生率相当(P=1.00)。随访期间两组均无复发病例。结论：FK506单用或与CTX联合行多靶点治疗均对难治性LN有较好疗效,均可有效降低尿蛋白。多靶点治疗组降低疾病活动度、提高血清白蛋白疗效优于FK506单用组。两组总的不良事件发生率相当,但多靶点治疗组出现胃肠不适的现象多于FK506单用组。
[Abstract]:Objective: to investigate the efficacy and safety of tacrolimus in the treatment of refractory lupus nephritis (LN). Methods: sixteen patients with refractory LN were randomly divided into two groups: FK506 group and FK506 CTX multi-target group. The dose of FK506 was 2 mg / d. A prospective follow-up of 24 weeks was carried out to observe the urinary protein / creatinine ratio (UPA / CR), routine blood and urine routine, liver and kidney function, adverse reactions and recurrence, and to compare the clinical efficacy and safety between the two groups. According to the index of up / R, serum albumin, the curative effect was divided into complete remission (CR), partial remission (PR) and ineffective NRV. Results: at 24 weeks after treatment, the total effective rate of FK506 group was 66.7 (including 1 CR and 3 PRL) and 50.0% (including 4 cases of FK506). The total effective rate of two groups was 66.7 (including 1 CR and 3 cases of PRD), and the total effective rate of both groups was 50.0% (including 4 cases of FK506), and the total effective rate of both groups was P0.627 P0.429 (1.00%). The total effective rate of FK506 group was 66.7% (including 1 case of CR and 3 cases of PRN), and that of multi-target group (8 cases). Up/cr decreased significantly after treatment in both groups. In multi-target treatment group, serum albumin increased the score of SLEDAI and decreased the level of dsDNA. There were 5 cases and 6 cases of adverse events in each group. In the FK506 group, 2 cases were stopped after 6 weeks and 8 weeks of treatment because of severe renal insufficiency, and 4 cases in the multi-target group showed gastrointestinal reaction, which was higher than that in the FK506 group (0.038%). The incidence of adverse events in the two groups was similar to that in the two groups. There were no recurrent cases in both groups during the follow-up period. Conclusion the multitarget therapy of WFK506 alone or in combination with CTX is effective in the treatment of refractory LN and can effectively reduce urinary protein. The multi-target treatment group reduced disease activity and increased serum albumin efficacy compared with FK506 alone group. The incidence of adverse events in the two groups was similar, but gastrointestinal discomfort was more common in the multi-target therapy group than in the FK506 alone group.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R593.242

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