摘要
目的旨在评估无糖皮质激素的免疫抑制治疗在膜性肾病(membranous nephrology,MN)合并2型糖尿病患者中的疗效和安全性。方法回顾性分析2009年1月至2017年1月在浙江大学医学院附属第一医院就诊的2型糖尿病合并肾活检证实的MN患者,分为无糖皮质激素组和对照组。无糖皮质激素组患者使用除糖皮质激素外的1种或联合2种免疫抑制剂,包括他克莫司、环孢素、雷公藤多苷、静脉注射环磷酰胺等;对照组患者采用糖皮质激素联合上述免疫抑制剂治疗。比较2组患者的疗效及不良反应发生率。结果本研究共纳入了64例患者,无糖皮质激素组26例,对照组38例。12个月时,无糖皮质激素组总缓解率为69.24%,对照组为73.68%(P=0.500);中位随访33个月(12~106个月),对照组2例患者进入血液透析,其中1例患者在透析1年后死亡;无糖皮质激素组1例患者意外死亡,没有患者进入透析。对照组所有患者血糖均升高,而无糖皮质激素组患者中只有5例患者血糖升高,且这5例患者均使用他克莫司。结论采用不联合糖皮质激素的免疫抑制方案治疗MN合并2型糖尿病患者,可减少对血糖水平的影响,具有一定的治疗缓解率。
Objective To evaluate the efficacy and safety of steroids-free immunosuppressive therapy including tacrolimus,cyclosporin A,tripterygium glycosides or intravenous cyclophosphamide in membranous nephropathy(MN)patients combined with type 2 diabetes mellitus(T2DM).Methods This study was a retrospective analysis of patients with T2DM complicated with biopsy proved MN in the First Affiliated Hospital,College of Medicine,Zhejiang University from January 2009 to January 2017.The patients were divided into steroids-free group and control group.The patients in steroids-free group were treated with one or two immunosuppressive agents except glucocorticoids.The patients in control group were treated with glucocorticoid combining with immunosuppressive agents.Results A total of 64 patients were enrolled in this study.There were 26 cases in steroids-free group and 38 cases in control group.The total remission rate was 69.24%in steroids-free group and 73.68%in control group at 12 months.In a median follow up of 33(12-106)months,two patients in control group entered hemodialysis and one of them died after 1 year of dialysis.One patient in steroids-free group died of accidental death and no patient entered dialysis.All patients in control group had elevated blood glucose level,whereas only 5 patients in steroids-free group had elevated blood glucose and all these 5 patients used tacrolimus.Conclusion Immunosuppressive regimen without glucocorticoid treatment can reduce side effects on blood glucose level in MN patients with type 2 diabetes,with a certain rate of treatment response.
作者
章敏巧
祝伊琳
郭俊敏
蔡珂丹
陈江华
韩飞
Zhang Minqiao;Zhu Yilin;Guo Junmin;Cai Kedan;Chen Jianghua;Han Fei(Kidney Disease Center,the First Affiliated Hospital,College of Medicine,Zhejiang University,Institute of Nephrology,Zhejiang University,Key Laboratory of Kidney Disease Prevention and Control Technology,Zhejiang Province,Hangzhou 310003,China;Department of Nephrology,the First People's Hospital of Xiangshan,Ningbo 315700,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2019年第12期893-898,共6页
Chinese Journal of Nephrology
基金
国家重点研发计划(2018YFC1314003)
国家自然科学基金(81570605、81770674)。
关键词
糖尿病
2型
肾小球肾炎
膜性
糖皮质激素类
免疫抑制剂
Diabetes mellitus,type 2
Glomerulonephritis,membranous
Glucocorticoids
Immunosuppressive agents
