单用他克莫司治疗特发性膜性肾病的回顾性临床观察
发布时间：2019-01-10 09:47
【摘要】：目的：比较单用他克莫司(tacrolimus, TAC)与激素联合他克莫司、激素联合环磷酰胺方案在治疗表现为肾病综合征的特发性膜性肾病(idiopathic membranous nephropathy, IMN)的有效性及安全性。 方法：选择2010年至2013年5月在浙江大学附属第一医院肾脏病中心行肾穿刺活检,病理表现为IMN,临床表现为肾病综合征的患者共36例,分为3组并接受不同治疗方案：单用TAC组初始治疗接受他克莫司胶囊口服,起始剂量0.05mg/kg.d,维持谷浓度4-10ng/ml;激素联合他克莫司组初始治疗接受强的松片0.5mg/kg.d,他克莫司胶囊起始剂量0.05mg/kg.d,维持谷浓度4-10ng/ml;激素+环磷酰胺组初始治疗接受强的松片0.5mg/kg.d,静脉环磷酰胺0.8-1.2g,每2周1次,8周后每4周1次,总量150mg/kg。观察3组患者点尿蛋白/肌酐比值(uPCR),血清白蛋白,血肌酐,估算的肾小球滤过率(estimated glomerular filtration rate, eGFR),谷丙转氨酶,总胆红素,血糖及其他不良事件。 结果：共纳入36例研究对象,治疗开始后12周,单用TAC组、激素联合TAC组、激素联合CTX组缓解率(CR及PR)分别为57.1%,57.8%,70%(p0.05)；治疗开始后24周,3组缓解率分别为60%,85.7%,71.4%(p0.05)。3组治疗后点尿蛋白/肌酐比值较基础值有显著下降(p0.05),血清白蛋白较治疗前显著上升(p0.05),3组组间比较差异无统计学意义(p0.05),治疗前后血肌酐、eGFR无统计学差异。单用TAC组治疗前后ALT及TB无显著改变(p0.05)。 结论：单用TAC可作为临床表现为肾病综合征的IMN患者的有效治疗方案,短期疗效与激素联合TAC、激素联合CTX无明显差异,患者耐受性好。
[Abstract]:Objective: to compare the efficacy and safety of tacrolimus (tacrolimus, TAC) alone and steroid combined with tacrolimus regimen and cyclophosphamide regimen in the treatment of idiopathic membranous nephropathy (idiopathic membranous nephropathy, IMN) with nephrotic syndrome. Methods: from 2010 to May 2013, a total of 36 patients with nephrotic syndrome (IMN,) were selected for renal biopsy in the Center of Renal Disease, the first affiliated Hospital of Zhejiang University. Three groups were divided into three groups: TAC group received oral tacrolimus capsule at the initial dose of 0.05 mg / kg 路d, and maintained the valley concentration of 4-10 ng / ml; The initial dose of prednisone and tacrolimus was 0.5 mg / kg 路d and 0.05 mg / kg 路d, respectively, and the valley concentration was 4-10 ng / ml. The hormone cyclophosphamide group received prednisone 0.5 mg / kg 路d, intravenous cyclophosphamide 0.8-1.2 g, once every 2 weeks, once every 4 weeks after 8 weeks, the total amount was 150 mg / kg. Serum albumin, serum creatinine, estimated glomerular filtration rate (estimated glomerular filtration rate, eGFR), total bilirubin, blood glucose and other adverse events were observed in three groups. Results: at 12 weeks after treatment, the remission rates (CR and PR) in TAC group, steroid combined TAC group and steroid combined CTX group were 57.1and 57.8%, respectively (p0.05). 24 weeks after treatment, the remission rate of the three groups was 60.85. 7% (p0.05). The urinary protein / creatinine ratio in the 3 groups was significantly lower than the basic value (p0.05). Serum albumin was significantly higher than that before treatment (p0. 05), but there was no significant difference among the three groups (p0. 05). There was no significant difference in serum creatinine and eGFR before and after treatment. There were no significant changes in ALT and TB in TAC group before and after treatment (p0.05). Conclusion: TAC alone can be used as an effective treatment regimen for IMN patients with nephrotic syndrome. There is no significant difference between the short-term therapeutic effect and steroid combined with TAC, hormone combined with CTX, and the patient has good tolerance.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.3
本文编号：2406193
[Abstract]:Objective: to compare the efficacy and safety of tacrolimus (tacrolimus, TAC) alone and steroid combined with tacrolimus regimen and cyclophosphamide regimen in the treatment of idiopathic membranous nephropathy (idiopathic membranous nephropathy, IMN) with nephrotic syndrome. Methods: from 2010 to May 2013, a total of 36 patients with nephrotic syndrome (IMN,) were selected for renal biopsy in the Center of Renal Disease, the first affiliated Hospital of Zhejiang University. Three groups were divided into three groups: TAC group received oral tacrolimus capsule at the initial dose of 0.05 mg / kg 路d, and maintained the valley concentration of 4-10 ng / ml; The initial dose of prednisone and tacrolimus was 0.5 mg / kg 路d and 0.05 mg / kg 路d, respectively, and the valley concentration was 4-10 ng / ml. The hormone cyclophosphamide group received prednisone 0.5 mg / kg 路d, intravenous cyclophosphamide 0.8-1.2 g, once every 2 weeks, once every 4 weeks after 8 weeks, the total amount was 150 mg / kg. Serum albumin, serum creatinine, estimated glomerular filtration rate (estimated glomerular filtration rate, eGFR), total bilirubin, blood glucose and other adverse events were observed in three groups. Results: at 12 weeks after treatment, the remission rates (CR and PR) in TAC group, steroid combined TAC group and steroid combined CTX group were 57.1and 57.8%, respectively (p0.05). 24 weeks after treatment, the remission rate of the three groups was 60.85. 7% (p0.05). The urinary protein / creatinine ratio in the 3 groups was significantly lower than the basic value (p0.05). Serum albumin was significantly higher than that before treatment (p0. 05), but there was no significant difference among the three groups (p0. 05). There was no significant difference in serum creatinine and eGFR before and after treatment. There were no significant changes in ALT and TB in TAC group before and after treatment (p0.05). Conclusion: TAC alone can be used as an effective treatment regimen for IMN patients with nephrotic syndrome. There is no significant difference between the short-term therapeutic effect and steroid combined with TAC, hormone combined with CTX, and the patient has good tolerance.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.3
【参考文献】
相关期刊论文 前1条
1 刘志红;吴青;汤曦;张明超;朱晓东;左科;郑春霞;曾彩虹;黎磊石;;膜性肾病患者足细胞钙神经蛋白表达的检测及其临床意义[J];肾脏病与透析肾移植杂志;2010年01期
，本文编号：2406193
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