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目的难治性特发性膜性肾病是临床治疗难题。本文前瞻性观察他克莫司联合激素治疗难治性特发性膜性肾病患者的疗效及安全性。方法经肾活检并结合临床诊断为难治性特发性膜性肾病8例;采用他克莫司[起始剂量0.05 mg/(kg·d),缓解者6个月后渐减量]联合使用激素[0.3~0.5 mg/(kg·d),2月后视病情以每1~2周减5 mg减至10 mg/d并维持]进行治疗;治疗期间每月随访,时间1年。随访期间测相关指标。用SPSS 13.0软件统计分析。结果本研究8例患者,治疗6个月后,1例患者完全缓解,5例患者部分缓解,总缓解率75.00%。治疗1年后,2例患者完全缓解,3例患者部分缓解,总缓解率62.50%。随访1年无一例患者复发。完成1年治疗患者5例,24小时尿蛋白水平较治疗前显著改善[(4.76±0.81)g/L vs.(1.31±1.14)g/L,P<0.01)];血清白蛋白水平较治疗前显著升高[(26.58±2.08)g/L vs.(34.78±2.92)g/L,P<0.01]。治疗过程中无严重不良事件。结论他克莫司联合激素对难治性特发性膜性肾病患者疗效较好,不良反应少,是治疗难治性特发性膜性肾病的有效方法。
Objective Refractory idiopathic membranous nephropathy is a clinical treatment problem. This prospective observation of tacrolimus combined with hormone therapy in patients with refractory idiopathic membranous nephropathy efficacy and safety. Methods Eight patients with refractory idiopathic membranous nephropathy were diagnosed by renal biopsy and combined with clinical diagnosis. Tacrolimus (initial dose of 0.05 mg / (kg · d) and dose reduction of 6 months after remission were used in combination) Hormone [0.3 ~ 0.5 mg / (kg · d), after February as the disease every 1 to 2 weeks minus 5 mg to 10 mg / d and maintain] for treatment; monthly follow-up during treatment, time 1 year. During follow-up test related indicators. Using SPSS 13.0 software statistical analysis. Results In the 8 patients studied, after 6 months of treatment, 1 patient was completely relieved and 5 patients partially relieved, with a total response rate of 75.00%. After 1 year of treatment, 2 patients were completely relieved and 3 patients were partially relieved, with a total response rate of 62.50%. None of the patients were followed up for 1 year. After completion of 1-year treatment in 5 patients, 24-hour urine protein level was significantly improved compared with that before treatment [(4.76 ± 0.81) g / L vs. (1.31 ± 1.14) g / L, P <0.01) (26.58 ± 2.08) g / L vs. (34.78 ± 2.92) g / L, P <0.01]. No serious adverse events during treatment. Conclusion The combination of tacrolimus with refractory idiopathic membranous nephropathy patients with better curative effect, fewer adverse reactions, is an effective treatment for refractory idiopathic membranous nephropathy.