本文選題：難治性狼瘡性腎炎 + 他克莫司��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：探討他克莫司對(duì)難治性狼瘡腎炎(LN)的療效及安全性。 方法：將16例難治性LN患者隨機(jī)分為FK506組和FK506+CTX的多靶點(diǎn)治療組,FK506劑量均為2mg/d,分早晚兩次口服,CTX0.6-1.2g/m。前瞻性隨訪24周,觀察兩組病例尿蛋白/肌酐比值(Up/cr)、血尿常規(guī)、肝腎功能、不良反應(yīng)及復(fù)發(fā)情況,比較兩組臨床療效及安全性。根據(jù)Up/cr、血清白蛋白等指標(biāo)將療效分為完全緩解(CR)、部分緩解(PR)及無效(NR)。 結(jié)果：治療24周時(shí)FK506組(2例提前退出,共完成6例)總有效率為66.7%(包括1例CR和3例PR),多靶點(diǎn)治療組(完成8例)總有效率50.0%(包括4例PR),兩組總有效率、CR及PR相當(dāng)(P=0.627,P=0.429,P=1.00)。兩組治療后Up/cr均較治療前明顯下降。多靶點(diǎn)治療組血清白蛋白較治療前升高,SLEDAI積分、抗dsDNA降低。兩組各有5例和6例病例出現(xiàn)不良事件。其中FK506組有2例病例因嚴(yán)重腎功能不全分別在治療6周和8周后停藥；多靶點(diǎn)治療組有4例出現(xiàn)胃腸反應(yīng),高于FK506組(P=0.038)。兩組總的不良事件發(fā)生率相當(dāng)(P=1.00)。隨訪期間兩組均無復(fù)發(fā)病例。 結(jié)論：FK506單用或與CTX聯(lián)合行多靶點(diǎn)治療均對(duì)難治性LN有較好療效,均可有效降低尿蛋白。多靶點(diǎn)治療組降低疾病活動(dòng)度、提高血清白蛋白療效優(yōu)于FK506單用組。兩組總的不良事件發(fā)生率相當(dāng),但多靶點(diǎn)治療組出現(xiàn)胃腸不適的現(xiàn)象多于FK506單用組。
[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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R593.242

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