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目的探究他克莫司对难治性成人原发性肾病综合征(PNS)患者激素应用剂量和骨代谢的影响。方法将2010年3月至2015年3月于平煤神马医疗集团总医院接受治疗的76例难治性PNS患者随机分为治疗组和对照组,每组38例。治疗组给予他克莫司+小剂量泼尼松治疗,对照组给予足量泼尼松治疗,两组均治疗6个月。比较两组患者治疗效果、肾功能指标以及骨代谢情况。结果治疗后,两组患者24 h尿蛋白定量(UP)显著降低(P<0.05),血清白蛋白(ALB)、血肌酐(Scr)较本组治疗前显著上升(P<0.05);治疗后,两组UP和ALB比较,差异有统计学意义(P<0.05),Scr差异无统计学意义(P>0.05);治疗组治疗总有效率92.10%,而对照组则为71.05%,两组差异有统计学意义(P<0.05);治疗后,两组患者血清钙(Ca)、磷(P)、骨钙素(BGP)含量均较本组治疗前显著下降(P<0.05),Ⅰ型胶原吡啶交联C终端肽(CTx)、25-羟基维生素D3[25(OH)D3]及骨密度(BMD)含量均显著上升(P<0.05),且治疗后对照组下降幅度显著高于治疗组(P<0.05)。结论他克莫司联合小剂量泼尼松治疗难治性成人PNS,比单用足量泼尼松治疗效果好,改善肾功能指标显著,对骨代谢影响小。
Objective To investigate the effects of tacrolimus on hormone dosage and bone metabolism in patients with refractory adult primary nephrotic syndrome (PNS). Methods Seventy-six patients with refractory PNS treated in Pingdingshan Shenma Medical Group General Hospital from March 2010 to March 2015 were randomly divided into treatment group and control group, with 38 cases in each group. The treatment group was given tacrolimus + low-dose prednisone, and the control group was given prednisone for a sufficient period of time. Both groups were treated for 6 months. The therapeutic effects, renal function and bone metabolism were compared between the two groups. Results After treatment, the urinary protein (UP) in 24 hours was significantly lower (P <0.05), and the serum albumin (ALB) and serum creatinine (Scr) (P <0.05). There was no significant difference in Scr between the two groups (P> 0.05). The total effective rate of the treatment group was 92.10%, while that of the control group was 71.05% (P <0.05). After treatment, the levels of serum Ca, P and BGP in the two groups were significantly lower than those before treatment (P <0.05), while the levels of Ⅰ (CTx), 25-hydroxyvitamin D3 [25 (OH) D3] and bone mineral density (BMD) increased significantly (P <0.05), and the decrease of the control group after treatment was significantly higher than that of the control group Treatment group (P <0.05). Conclusions Tacrolimus combined with low-dose prednisone in the treatment of refractory adult PNS is more effective than single-dose prednisone treatment, with significant improvement of renal function and little effect on bone metabolism.