Objective To investigate the clinical effect of tacrolimus in the treatment of idiopathic membranous nephropathy (IMN).
Methods According to the treatment intention, the patients were divided into observation group (28 cases) and control group (16 cases). The observation group was treated with tacrolimus, while the control group was treated with glucocorticoid combined with cyclophosphamide. 24-hour urine protein, creatinine, urea and albumin were measured before treatment, 3 months after treatment and 6 months after treatment. The anti-M-phospholipase A2 receptor 1 antibody (PLA2R- Ab) was determined. The therapeutic effect of the two groups was evaluated after 6 months of treatment.
Results 24 h urine protein quantity, ALB, TG and TC in the observation group and the control group were significantly improved after 3 and 6 months of treatment ( P<0.05); and the improvement in the observation group was more obvious than that in the control group ( P<0.05); Scr and BUN in the observation group increased after 6 months of treatment ( P<0.05); FBG and WBC in the control group were significantly increased after 3 and 6 months of treatment ( P<0.05). The blood PLA2R-Ab of the two groups decreased significantly in 3 and 6 months after treatment ( P<0.05); and compared with the three months after treatment, the blood PLA2R-Ab of the two groups decreased more significantly in 6 months after treatment ( P<0.05); the observation group decreased significantly in 3 and 6 months after treatment compared with the control group at the same time ( P<0.05). Six months after treatment, the remission rate of the observation group was 85.7%, and that of the control group was 68.8%. The remission rate of the observation group was significantly higher than that of the control group ( P<0.05). In the observation group, 3 patients showed slight increase of serum creatinine, 1 case of gingival hyperplasia; in the control group, 3 cases of hyperglycemia, 2 cases of nausea and vomiting.
Conclusion Tacrolimus is effective in the treatment of IMN, with mild side effects and a significant reduction of blood PLA2R-Ab.
摘要：目的 探讨他克莫司治疗特发性膜性肾病（IMN）临床效果。 方法 根据患者治疗意愿分为观察组 28 例，对 照组 16 例；观察组采用他克莫司治疗，对照组采用激素联合环磷酰胺治疗。测定两组患者治疗前及治疗后 3 个月、6 个 月 24 h 尿蛋白定量、血肌酐、血尿素、血白蛋白和抗 M 型磷脂酶 A2 受体 1 的抗体(PLA2R-Ab)。两组患者均在治疗 6 个 月后评价治疗效果。 结果 两组患者在治疗 3 个月、6 个月后 24 h 尿蛋白定量、血白蛋白、三酰甘油、胆固醇均有明显改 善，差异均有统计学意义（ P<0.05)；并且观察组较对照组改善更明显（ P<0.05）；观察组治疗 6 个月后血肌酐、尿素较治疗 前有升高，差异均有统计学意义（ P<0.05）；对照组空腹血糖、白细胞治疗 3 个月、6 个月后较治疗前升高，差异有统计学 意义（ P<0.05）。两组患者治疗 3 个月、6 个月后血 PLA2R-Ab 均有明显降低，差异均有统计学意义（ P<0.05)；并且与治疗 3 个月比较，两组治疗 6 个月后血 PLA2R-Ab 降低更明显（ P<0.05）；观察组治疗后 3 个月、6 个月后均较对照组同时间降 低更明显（ P<0.05）。治疗后 6 个月，观察组缓解率 85.7%，对照组缓解率 68.8%，缓解率差异有统计学意义（ P<0.05）。 观察组中 3 例患者出现血肌酐轻度增高，1 例牙龈增生；对照组 3 例血糖升高，2 例恶心呕吐。 结论 他克莫司治疗 IMN 效果明显，不良反应轻微，明显降低血 PLA2R-Ab。