單用他克莫司治療特發(fā)性膜性腎病的回顧性臨床觀察
發(fā)布時(shí)間：2019-01-10 09:47
【摘要】：目的：比較單用他克莫司(tacrolimus, TAC)與激素聯(lián)合他克莫司、激素聯(lián)合環(huán)磷酰胺方案在治療表現(xiàn)為腎病綜合征的特發(fā)性膜性腎病(idiopathic membranous nephropathy, IMN)的有效性及安全性。 方法：選擇2010年至2013年5月在浙江大學(xué)附屬第一醫(yī)院腎臟病中心行腎穿刺活檢,病理表現(xiàn)為IMN,臨床表現(xiàn)為腎病綜合征的患者共36例,分為3組并接受不同治療方案：?jiǎn)斡肨AC組初始治療接受他克莫司膠囊口服,起始劑量0.05mg/kg.d,維持谷濃度4-10ng/ml;激素聯(lián)合他克莫司組初始治療接受強(qiáng)的松片0.5mg/kg.d,他克莫司膠囊起始劑量0.05mg/kg.d,維持谷濃度4-10ng/ml;激素+環(huán)磷酰胺組初始治療接受強(qiáng)的松片0.5mg/kg.d,靜脈環(huán)磷酰胺0.8-1.2g,每2周1次,8周后每4周1次,總量150mg/kg。觀察3組患者點(diǎn)尿蛋白/肌酐比值(uPCR),血清白蛋白,血肌酐,估算的腎小球?yàn)V過(guò)率(estimated glomerular filtration rate, eGFR),谷丙轉(zhuǎn)氨酶,總膽紅素,血糖及其他不良事件。 結(jié)果：共納入36例研究對(duì)象,治療開(kāi)始后12周,單用TAC組、激素聯(lián)合TAC組、激素聯(lián)合CTX組緩解率(CR及PR)分別為57.1%,57.8%,70%(p0.05)；治療開(kāi)始后24周,3組緩解率分別為60%,85.7%,71.4%(p0.05)。3組治療后點(diǎn)尿蛋白/肌酐比值較基礎(chǔ)值有顯著下降(p0.05),血清白蛋白較治療前顯著上升(p0.05),3組組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),治療前后血肌酐、eGFR無(wú)統(tǒng)計(jì)學(xué)差異。單用TAC組治療前后ALT及TB無(wú)顯著改變(p0.05)。 結(jié)論：?jiǎn)斡肨AC可作為臨床表現(xiàn)為腎病綜合征的IMN患者的有效治療方案,短期療效與激素聯(lián)合TAC、激素聯(lián)合CTX無(wú)明顯差異,患者耐受性好。
[Abstract]:Objective: to compare the efficacy and safety of tacrolimus (tacrolimus, TAC) alone and steroid combined with tacrolimus regimen and cyclophosphamide regimen in the treatment of idiopathic membranous nephropathy (idiopathic membranous nephropathy, IMN) with nephrotic syndrome. Methods: from 2010 to May 2013, a total of 36 patients with nephrotic syndrome (IMN,) were selected for renal biopsy in the Center of Renal Disease, the first affiliated Hospital of Zhejiang University. Three groups were divided into three groups: TAC group received oral tacrolimus capsule at the initial dose of 0.05 mg / kg 路d, and maintained the valley concentration of 4-10 ng / ml; The initial dose of prednisone and tacrolimus was 0.5 mg / kg 路d and 0.05 mg / kg 路d, respectively, and the valley concentration was 4-10 ng / ml. The hormone cyclophosphamide group received prednisone 0.5 mg / kg 路d, intravenous cyclophosphamide 0.8-1.2 g, once every 2 weeks, once every 4 weeks after 8 weeks, the total amount was 150 mg / kg. Serum albumin, serum creatinine, estimated glomerular filtration rate (estimated glomerular filtration rate, eGFR), total bilirubin, blood glucose and other adverse events were observed in three groups. Results: at 12 weeks after treatment, the remission rates (CR and PR) in TAC group, steroid combined TAC group and steroid combined CTX group were 57.1and 57.8%, respectively (p0.05). 24 weeks after treatment, the remission rate of the three groups was 60.85. 7% (p0.05). The urinary protein / creatinine ratio in the 3 groups was significantly lower than the basic value (p0.05). Serum albumin was significantly higher than that before treatment (p0. 05), but there was no significant difference among the three groups (p0. 05). There was no significant difference in serum creatinine and eGFR before and after treatment. There were no significant changes in ALT and TB in TAC group before and after treatment (p0.05). Conclusion: TAC alone can be used as an effective treatment regimen for IMN patients with nephrotic syndrome. There is no significant difference between the short-term therapeutic effect and steroid combined with TAC, hormone combined with CTX, and the patient has good tolerance.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R692.3
本文編號(hào)：2406193
[Abstract]:Objective: to compare the efficacy and safety of tacrolimus (tacrolimus, TAC) alone and steroid combined with tacrolimus regimen and cyclophosphamide regimen in the treatment of idiopathic membranous nephropathy (idiopathic membranous nephropathy, IMN) with nephrotic syndrome. Methods: from 2010 to May 2013, a total of 36 patients with nephrotic syndrome (IMN,) were selected for renal biopsy in the Center of Renal Disease, the first affiliated Hospital of Zhejiang University. Three groups were divided into three groups: TAC group received oral tacrolimus capsule at the initial dose of 0.05 mg / kg 路d, and maintained the valley concentration of 4-10 ng / ml; The initial dose of prednisone and tacrolimus was 0.5 mg / kg 路d and 0.05 mg / kg 路d, respectively, and the valley concentration was 4-10 ng / ml. The hormone cyclophosphamide group received prednisone 0.5 mg / kg 路d, intravenous cyclophosphamide 0.8-1.2 g, once every 2 weeks, once every 4 weeks after 8 weeks, the total amount was 150 mg / kg. Serum albumin, serum creatinine, estimated glomerular filtration rate (estimated glomerular filtration rate, eGFR), total bilirubin, blood glucose and other adverse events were observed in three groups. Results: at 12 weeks after treatment, the remission rates (CR and PR) in TAC group, steroid combined TAC group and steroid combined CTX group were 57.1and 57.8%, respectively (p0.05). 24 weeks after treatment, the remission rate of the three groups was 60.85. 7% (p0.05). The urinary protein / creatinine ratio in the 3 groups was significantly lower than the basic value (p0.05). Serum albumin was significantly higher than that before treatment (p0. 05), but there was no significant difference among the three groups (p0. 05). There was no significant difference in serum creatinine and eGFR before and after treatment. There were no significant changes in ALT and TB in TAC group before and after treatment (p0.05). Conclusion: TAC alone can be used as an effective treatment regimen for IMN patients with nephrotic syndrome. There is no significant difference between the short-term therapeutic effect and steroid combined with TAC, hormone combined with CTX, and the patient has good tolerance.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R692.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 劉志紅;吳青;湯曦;張明超;朱曉東;左科;鄭春霞;曾彩虹;黎磊石;;膜性腎病患者足細(xì)胞鈣神經(jīng)蛋白表達(dá)的檢測(cè)及其臨床意義[J];腎臟病與透析腎移植雜志;2010年01期
，本文編號(hào)：2406193
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