徐毅芳　徐莹

[摘要] 目的 觀察他克莫司联合糖皮质激素治疗特发性膜性肾病的疗效。 方法 选择2012 年12月～2014年12月于我院住院治疗的特发性膜性肾病患者120例，随机分为观察组和对照组，每组各60例，两组均予常规治疗和对症治疗。观察组同时联合他克莫司联合糖皮质激素治疗，治疗后比较两组的临床疗效以及比较两组患者尿蛋白、血清白蛋白、血肌酐水平治疗前后的变化。 结果 观察组治疗后未缓解3例，对照组治疗后未缓解18例。观察组治疗后的总缓解率（95.00%）显著高于对照组（70.00%），组间疗效比较有统计学差异（P<0.05）。两组治疗前尿蛋白、血清白蛋白、血肌酐水平比较无统计学差异（P>0.05）；治疗后两组尿蛋白水平显著降低，血清白蛋白显著升高，差异有统计学意义（P<0.05）；且观察组患者治疗后尿蛋白水平显著低于对照组，血清白蛋白显著高于对照组（P<0.05）。但两组患者血肌酐水平治疗前后以及组间比较未见明显差异（P>0.05）。 结论 他克莫司联合糖皮质激素治疗特发性膜性肾病疗效显著，可以显著改善肾功能，值得推广和应用。

[关键词] 特发性膜性肾病；他克莫司；糖皮质激素；血肌酐

[中图分类号] R692 [文献标识码] B [文章编号] 1673-9701（2017）12-0122-03

[Abstract] Objective To observe the efficacy of tacrolimus combined with glucocorticoid in the treatment of idiopathic membranous nephropathy. Methods 120 patients with idiopathic membranous nephropathy who were hospitalized in our hospital from December 2012 to December 2014 were selected. 120 cases of idiopathic membranous nephropathy were randomly divided into the observation group and the control group， with 60 cases in each group. Both groups were given routine treatment and symptomatic treatment. The observation group was treated with tacrolimus combined with glucocorticoid. After treatment， the clinical efficacy was compared between the two groups， and changes of urinary protein， serum albumin and serum creatinine were compared before and after the treatment. Results In the observation group， 3 cases were not remission after the treatment and 18 cases were not remission in the control group after treatment. The total remission rate（95.00%） in the observation group after the treatment was significantly higher than that in the control group（70.00%）， and the difference in the efficacy between groups was statistically significant（P<0.05）. There were no statistically significant differences in urinary protein， serum albumin and serum creatinine before the treatment between the two groups（P>0.05）； after treatment， the levels of urine protein were significantly decreased， and serum albumin was significantly increased in both groups. The differences were statistically significant（P<0.05）； and the level of urinary protein in the observation group was significantly lower than that in the control group after the treatment， and serum albumin was significantly higher than the control group. There was statistically significant difference between the two groups（P<0.05）. However， there was no significant difference in serum creatinine level before and after treatment and between the two groups（P>0.05）. Conclusion Tacrolimus combined with glucocorticoid in the treatment of idiopathic membranous nephropathy has a significant efficacy， which can significantly improve the renal function， and is worthy of promotion and application.

[Key words] Idiopathic membranous nephropathy； Tacrolimus； Glucocordicoid； Serum creatinine

特发性膜性肾病（idiopathic membranous nephropathy，IMN）约占膜性肾病（membranous nephropathy，MN）的 2/3，是中老年原发性肾病综合征患者常见的病理类型，高峰年龄为50～60岁[1-2]。糖皮质激素为治疗IMN的常用药物，但单用激素不能明显降低尿蛋白，不推荐单独应用[3-5]。他克莫司（tacrolimus，TAC）是一种新型强效免疫抑制剂，其作用机制虽与环孢素类似，但免疫抑制作用是环孢素的数十倍甚至百倍[6]。本研究旨在探讨他克莫司与糖皮质激素联合应用治疗特发性膜性肾病的疗效，现报道如下。

1 资料与方法

1.1一般资料

选择2012年12月～2014年12月于我院住院治疗的特发性膜性肾病患者120例，患者治疗前3个月内未使用过糖皮质激素或免疫抑制剂，均签署知情同意书，排除严重的肝、肾功能不全，股骨头坏死、活动性消化性溃疡、药物过敏者及妊娠或哺乳期女性。……