【摘要】：目的比較他克莫司與環(huán)磷酰胺對(duì)特發(fā)性膜性腎病(IMN)患者的療效及性激素水平的影響。方法選擇以腎病綜合征為表現(xiàn)的IMN患者46例,分為他克莫司組28例、對(duì)照組18例。他克莫司組給予他克莫司膠囊0.05~0.1 mg/(kg·d),每天分2次空腹服用;醋酸潑尼松片起始劑量0.5 mg/(kg·d)晨起口服,1次/d,8周后減量。對(duì)照組給予環(huán)磷酰胺0.8 g靜脈滴注,每2周1次;同時(shí)給予醋酸潑尼松片1.0 mg/(kg·d)晨起口服,1次/d,8周后減量。兩組均治療3個(gè)月。治療前、治療1個(gè)月、治療3個(gè)月時(shí),檢測(cè)兩組24 h尿蛋白定量、血漿白蛋白水平;治療前及治療3個(gè)月時(shí),檢測(cè)兩組性激素中睪酮(T)、雌二醇(E2)、卵泡刺激素(FSH)、黃體生成素(LH)、泌乳素(PRL)、性激素結(jié)合球蛋白(SBG)水平。結(jié)果與治療前相比,他克莫司組治療1個(gè)月時(shí)24 h尿蛋白定量減少、血清白蛋白水平增高(P均0.05),環(huán)磷酰胺組治療1個(gè)月時(shí)24 h尿蛋白定量減少(P0.05);兩組治療3個(gè)月時(shí)24 h尿蛋白定量均減少,血清白蛋白水平均增高(P均0.05)。與環(huán)磷酰胺組相比,他克莫司組治療1、3個(gè)月時(shí)24 h尿蛋白定量減少,血清白蛋白水平增高(P均0.05)。與治療前比較,兩組治療3個(gè)月時(shí)血清E2、T及SBG水平均下降,FSH及LH水平均升高(P均0.05)。治療3個(gè)月時(shí),他克莫司組血清E2、T及SBG水平均高于對(duì)照組,FSH水平低于對(duì)照組(P均0.05)。他克莫司組不良反應(yīng)發(fā)生率低于對(duì)照組(P0.05)。結(jié)論與環(huán)磷酰胺方案比較,對(duì)臨床表現(xiàn)為腎病綜合征的IMN患者選用他克莫司方案起效更快、效果更好,且對(duì)性激素的抑制作用較小。
[Abstract]:Objective to compare the effect of tacrolimus and cyclophosphamide on (IMN) patients with idiopathic membranous nephropathy. Methods 46 IMN patients with nephrotic syndrome were divided into tacrolimus group (n = 28) and control group (n = 18). Tacrolimus group was given tacrolimus capsule 0.05 mg/ (kg d), twice a day, and prednisone acetate tablet was given orally for 8 weeks after 0.5 mg/ (kg d). The control group was given cyclophosphamide 0.8 g intravenously once every 2 weeks, and prednisone acetate tablet was given orally at 1 / d for 8 weeks from 1 mg/ (kg d) in the morning. Both groups were treated for 3 months. Before treatment, 1 month after treatment, 3 months after treatment, the levels of 24 h urinary protein and plasma albumin were measured in both groups, and before and after 3 months of treatment, The levels of testosterone (T), estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), (PRL), sex hormone binding globulin (SBG) in the two groups were measured. Results compared with those before treatment, the urinary protein in tacrolimus group decreased at 24 h after 1 month treatment. The level of serum albumin increased (P 0.05), and the urine protein of 24 h decreased in cyclophosphamide group at 1 month (P0.05), and decreased at 3 months after treatment in both groups (all P 0.05). Compared with cyclophosphamide group, the urinary protein and serum albumin in tacrolimus group decreased at 24 h after 1 month treatment (all P 0.05). Compared with those before treatment, the levels of serum E2T and SBG decreased and the levels of FSH and LH increased at 3 months after treatment in both groups (P < 0. 05). After 3 months of treatment, the serum levels of E2FSH and SBG in tacrolimus group were significantly higher than those in control group (P < 0. 05). The incidence of adverse reactions in tacrolimus group was lower than that in control group (P0.05). Conclusion compared with cyclophosphamide regimen, tacrolimus regimen is more effective and less effective than cyclophosphamide regimen in IMN patients with nephrotic syndrome.
【作者單位】： 鄭州大學(xué)第二附屬醫(yī)院;新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院;
【基金】：河南省科技發(fā)展計(jì)劃項(xiàng)目(142102310300)
【分類號(hào)】：R692

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