摘要
目的难治性特发性膜性肾病是临床治疗难题。本文前瞻性观察他克莫司联合激素治疗难治性特发性膜性肾病患者的疗效及安全性。方法经肾活检并结合临床诊断为难治性特发性膜性肾病8例；采用他克莫司[起始剂量0．05mg／（kg·d），缓解者6个月后渐减量]联合使用激素[0．3—0．5mg／（kg·d），2月后视病情以每1～2周减5mg减至10mg／d并维持]进行治疗；治疗期间每月随访，时间1年。随访期间测相关指标。用SPSS13．0软件统计分析。结果本研究8例患者，治疗6个月后，1例患者完全缓解，5例患者部分缓解，总缓解率75．00％。治疗1年后，2例患者完全缓解，3例患者部分缓解，总缓解率62．50％。随访1年无一例患者复发。完成1年治疗患者5例，24小时尿蛋白水平较治疗前显著改善[（4．76±0．81）g／Lvs．（1．31±1．14）g／L，P〈0．01）]；血清白蛋白水平较治疗前显著升高[（26．58±2．08）g／LVS．（34．78±2．92）g／L，P〈0．01]。治疗过程中无严重不良事件。结论他克莫司联合激素对难治性特发性膜性肾病患者疗效较好，不良反应少，是治疗难治性特发性膜性肾病的有效方法。
Objective To investigate the effect and safety of tacrolimus combined with corticosteroids in treatment of the refractory idiopathic membranous nephropathy. Methods Eight cases of refractory idiopathic membranous nephropathy demonstrated by biopsy combined with clinical manifestation were enrolled in this trial. Tacrolimus was started at a dose of 0.05 mg/（kg d）, after 6-month,the dose was reduced every month. All subjects received concomitant corticosteroid therapy according to the protocol which consisting of oral corticosteroid at an initial dose of 0.3 -0.5 mg/（ kg d）. Corti- costeroid was gradually tapered by 5 mg every 1 - 2 weeks after 2 months until a daily dose of 10 mg,/d was achieved, which was then maintained to the end of 12 months. On every follow-up visit, related indicators were measured. Results After 6 months ,complete remission was achieved in 12.50% of patients and partial remission in 62.50% ,yielding a re- sponse rate of 75.00%. After 12 months, complete remission was achieved in 25.00% of patients and partial remission in 37.50% , yielding a response rate of 62.50%. No case relapsed. 5 patients completed the treatment for 1 year. The urinary protein excretion decreased from （4.76 ± 0.81 ） g/24 h to （ 1.31 ± 1.14） g/24 h （ P 〈 0.01 ） ; the serum albumin in- creased from （26.58 ± 2.08） g/L to （34.78 ± 2.92） g/L（ P 〈 0.01 ）. None of serious adverse events were happened. Conclusion Tacrolimus plus corticosteroids may be an alternative therapeutic option for refractory idiopathic membra- nous nephropathy patients, with a favorable safety profile.
出处
《中华全科医学》
2014年第4期522-524,612,F0003,共5页
Chinese Journal of General Practice
基金
浙江省宁波市自然科学基金(2012A610253)
关键词
难治性
膜性肾病
他克莫司
糖皮质激素
Refractory membranous nephropathy
Tacrolimus
Glucocorticoid
