他克莫司与来氟米特治疗特发性膜性肾病的效果及安全性对比(1)
[摘要]目的 探讨他克莫司与来氟米特治疗特发性膜性肾病的效果及安全性比较。方法 选取2015年6月～2017年1月因膜性肾病于我院就诊的80例患者作为研究对象，采用随机数字表法分为对照组和观察组，每组各40例。所有患者常规应用泼尼松，除此以外对照组患者联合来氟米特治疗，观察组患者联合他克莫司，6个月为1个疗程。比较两组患者的临床疗效差异。结果 治疗后观察组患者24 h尿蛋白、血肌酐等肾功能指标均低于对照组，差异有统计学意义(P<0.05)；治疗后观察组患者的三酰甘油(TG)、总胆固醇(TC)等血脂水平低于对照组，差异有统计学意义(P<0.05)；观察组患者治疗的总有效率(77.50%)高于对照组(55.00%)，差异有统计学意义(P<0.05)；观察组不良反应的总发生率(30.00%)高于对照组(13.33%)，差异有统计学意义(P<0.05)。结论 较来氟米特而言，他克莫司治疗特发性膜性肾病效果更为显著，可有效改善肾功能及血脂水平，安全可靠，值得推广。
[关键词]他克莫司；来氟米特；特发性膜性肾病；安全性；肾功能
[中图分类号] R979.5 [文献标识码] A [文章编号] 1674-4721(2018)1(b)-0138-04
[Abstract]Objective To compare the efficacy and safety of tacrolimus and leflunomide in the treatment of idiopathic membranous nephropathy.Methods 80 patients with membranous nephropathy treated in our hospital from June 2015 to January 2017 were selected as the subjects，and divided into control group and observation group according to random data table method，40 cases in each group.All patients were treated with prednisone regularly.In addition，patients in the control group were treated with leflunomide，and patients in the observation group were treated with tacrolimus，6 months for a course of treatment.The difference of clinical efficacy between the two groups was compared.Results After treatment，the renal function indexes such as 24 h urinary protein and serum creatinine in the observation group were lower than those in the control group，the difference was statistically significant (P<0.05).Triglyceride (TG)，total cholesterol (TC) and other blood lipid levels in the observation group were lower than those in the control group，the difference was statistically significant (P<0.05).The total effective rate of the observation group (77.50%) was higher than that of the control group (55.00%)，the difference was statistically significant (P<0.05).The total incidence of adverse reactions in the observation group (30.00%) was higher than that of the control group (13.33%)，the difference was statistically significant (P<0.05).Conclusion For leflunomide，tacrolimus is more effective in the treatment of idiopathic membranous nephropathy.Tacrolimus can effectively improve renal function and blood lipid levels，safe and reliable，which is worthy of promotion.
[Key words]Tacrolimus；Leflunomide；Idiopathic membranous nephropathy；Safety；Renal function
特發性膜性肾病又称膜性肾小球肾炎，是引起成人肾病综合征的主要病理类型，以基底膜上皮细胞下大量免疫复合物沉积并伴有肾小球基底膜增厚为特点，大多患者不存在继发性疾病病因[1-2]。本病好发于中老年人，病机复杂，目前认为抗原所致的原位或局部免疫复合物形成在起病过程中发挥着关键作用[3]。本病依据症状及肾活检较易确诊，但治疗难度大且病情反复，其中约20%的患者可在10年内发展为肾功能衰竭[4]。治疗上目前多主张糖皮质激素与免疫抑制剂联合应用，对于延缓病情及保护肾功能方面可取得一定疗效。他克莫司与来氟米特均是临床常用的免疫抑制剂，本研究对两者的疗效进行观察，现报道如下。, http://www.100md.com(王天祺 杨颖达)
[关键词]他克莫司；来氟米特；特发性膜性肾病；安全性；肾功能
[中图分类号] R979.5 [文献标识码] A [文章编号] 1674-4721(2018)1(b)-0138-04
[Abstract]Objective To compare the efficacy and safety of tacrolimus and leflunomide in the treatment of idiopathic membranous nephropathy.Methods 80 patients with membranous nephropathy treated in our hospital from June 2015 to January 2017 were selected as the subjects，and divided into control group and observation group according to random data table method，40 cases in each group.All patients were treated with prednisone regularly.In addition，patients in the control group were treated with leflunomide，and patients in the observation group were treated with tacrolimus，6 months for a course of treatment.The difference of clinical efficacy between the two groups was compared.Results After treatment，the renal function indexes such as 24 h urinary protein and serum creatinine in the observation group were lower than those in the control group，the difference was statistically significant (P<0.05).Triglyceride (TG)，total cholesterol (TC) and other blood lipid levels in the observation group were lower than those in the control group，the difference was statistically significant (P<0.05).The total effective rate of the observation group (77.50%) was higher than that of the control group (55.00%)，the difference was statistically significant (P<0.05).The total incidence of adverse reactions in the observation group (30.00%) was higher than that of the control group (13.33%)，the difference was statistically significant (P<0.05).Conclusion For leflunomide，tacrolimus is more effective in the treatment of idiopathic membranous nephropathy.Tacrolimus can effectively improve renal function and blood lipid levels，safe and reliable，which is worthy of promotion.
[Key words]Tacrolimus；Leflunomide；Idiopathic membranous nephropathy；Safety；Renal function
特發性膜性肾病又称膜性肾小球肾炎，是引起成人肾病综合征的主要病理类型，以基底膜上皮细胞下大量免疫复合物沉积并伴有肾小球基底膜增厚为特点，大多患者不存在继发性疾病病因[1-2]。本病好发于中老年人，病机复杂，目前认为抗原所致的原位或局部免疫复合物形成在起病过程中发挥着关键作用[3]。本病依据症状及肾活检较易确诊，但治疗难度大且病情反复，其中约20%的患者可在10年内发展为肾功能衰竭[4]。治疗上目前多主张糖皮质激素与免疫抑制剂联合应用，对于延缓病情及保护肾功能方面可取得一定疗效。他克莫司与来氟米特均是临床常用的免疫抑制剂，本研究对两者的疗效进行观察，现报道如下。, http://www.100md.com(王天祺 杨颖达)