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目的观察对比他克莫司或来氟米特联合泼尼松治疗特发性膜性肾病的疗效及安全性。方法选取在榆林市第二医院就诊的经肾活检诊断为膜性肾病的80例患者,随机分为观察组(他克莫司+泼尼松)和对照组(来氟米特+泼尼松)各40例。对比两组治疗前后血清白蛋白、血糖、24 h尿蛋白定量、血清胆固醇、血清三酰甘油及血肌酐变化。结果观察组完全缓解和部分缓解各16例,无效8例,临床缓解率80.00%;对照组完全缓解8例,部分缓解13例,无效19例,临床缓解率52.50%。观察组临床缓解率明显高于对照组(P<0.05)。两组治疗8周及24周24 h尿蛋白定量、三酰甘油均较治疗前明显降低(P<0.05);两组治疗8周及24周时白蛋白较治疗前明显升高(P<0.05)。观察组治疗24周后24 h尿蛋白定量、三酰甘油均显著低于对照组(P<0.05);观察组治疗24周后白蛋白显著高于照组(P<0.05)。两组患者治疗4、8、24周后血糖、血清肌酐变化无统计学意义。两组不良反应比较,差异无统计学意义。结论他克莫司联合激素治疗特发性膜性肾病的效果较好,可延缓肾功能恶化,安全性好。
Objective To observe the efficacy and safety of tacrolimus or leflunomide combined with prednisone in the treatment of idiopathic membranous nephropathy. Methods Eighty patients diagnosed as membranous nephropathy by renal biopsy in the second hospital of Yulin City were randomly divided into observation group (tacrolimus + prednisone) and control group (leflunomide + prednisone) ) 40 cases each. Before and after treatment, serum albumin, blood glucose, 24 h urinary protein, serum cholesterol, serum triglyceride and serum creatinine were compared. Results In the observation group, 16 cases were completely relieved and partially relieved, 8 cases were ineffective, and the clinical remission rate was 80.00%. In the control group, 8 cases were completely relieved, 13 cases partially relieved, and 19 cases were ineffective. The clinical remission rate was 52.50%. The clinical remission rate in observation group was significantly higher than that in control group (P <0.05). After 24 and 24 weeks of treatment, 24-hour urinary protein excretion and triacylglycerol in both groups were significantly lower than those before treatment (P <0.05); albumin in both groups was significantly higher at 8 and 24 weeks (P <0.05) ). After 24 weeks of treatment, 24-hour urine protein and triglyceride contents in the observation group were significantly lower than those in the control group (P <0.05). After 24 weeks of treatment, the albumin level in the observation group was significantly higher than that in the control group (P <0.05). Two groups of patients after treatment 4,8,24 weeks of blood glucose, serum creatinine had no significant change. Adverse reactions between the two groups, the difference was not statistically significant. Conclusion Tacrolimus combined with hormone treatment of idiopathic membranous nephropathy better, can delay the deterioration of renal function, good safety.