多靶点治疗难治性特发性膜性肾病的前瞻性研究

发布时间：2019-02-20 22:00

【摘要】：目的特发性膜性肾病(IMN)是成人原发性肾病综合征的常见原因。本研究主要是观察多靶点治疗方案对难治性IMN的疗效及安全性。方法将符合标准的45例难治性IMN患者随机分组,其中多靶点治疗组23例,环磷酰胺(CTX)组22例。多靶点治疗组:他克莫司(FK506)起始量为0.05 mg/(kg·d),24 h血药谷浓度维持在3~6 ng/ml,吗替麦考酚酯(MMF)起始量为1.0 g/d;CTX对照组:CTX 100 mg/d,口服3个月(总剂量9 g)。糖皮质激素:强的松0.5 mg/(kg·d),8周后根据复查指标调整剂量。观察两组治疗前后24 h尿蛋白定量、血清白蛋白和血肌酐等疗效指标及不良反应。结果治疗6个月后,多靶点组缓解(完全缓解+部分缓解)率为75%(15例),CTX组缓解率为40%(8例),两组缓解率差异有统计学意义(P=0.013)。在治疗过程中两组患者未见严重不良反应。结论多靶点治疗在难治性IMN患者中安全有效,但其长期疗效及复发率尚需进一步研究观察。
[Abstract]:Objective: idiopathic membranous nephropathy (IMN) is a common cause of adult primary nephrotic syndrome. The purpose of this study was to observe the efficacy and safety of multi-target therapy in the treatment of refractory IMN. Methods Forty-five patients with refractory IMN were randomly divided into multi-target group (23 cases) and cyclophosphamide (CTX) group (22 cases). In the multi-target group, the initial dose of tacrolimus (FK506) was 0. 05 mg/ (kg d), for 24 h and the initial dose of (MMF) was 1. 0 g / d. CTX control group: CTX 100 mg/d, orally for 3 months (total dose 9 g).) Glucocorticoid: the dose of prednisone was adjusted 8 weeks after 0. 5 mg/ (kg d),. 24 h urinary protein, serum albumin and creatinine were measured before and after treatment. Results after 6 months of treatment, the remission rate of multiple target group (complete remission partial remission) was 75% (15 cases of), CTX group was 40% (8 cases), the difference between the two groups was statistically significant (P0.013). No serious adverse reactions were observed in the two groups during the course of treatment. Conclusion Multi-target therapy is safe and effective in refractory IMN patients, but its long-term curative effect and recurrence rate need to be further studied and observed.
【作者单位】：郑州大学第一附属医院肾内科;
【基金】：河南省医学科技攻关计划项目(20151010)
【分类号】：R692

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