低浓度他克莫司联合激素治疗特发性局灶节段肾小球硬化的回顾性对照研究
| 作者: |
1刘宝莲,
1申兵冰,
1张湖海,
1潘乾广,
1赵洪雯
1 中国人民解放军陆军军医大学第一附属医院肾科，重庆 400038 |
| 通讯: |
赵洪雯
Email: zhaohw212@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.05.020 |
| 基金: | 吴阶平医学基金会临床科研专项资助基金(320.6750.16190)。 |
摘要
目的：研究低浓度他克莫司(tacrolimus，TAC)联合糖皮质激素在特发性局灶节段肾小球硬化(focal segmental glomerulosclerosis，FSGS)中的有效性和安全性。方法：回顾筛选特发性FSGS，尿蛋白定量>1 000 mg/24 h的41例患者为研究对象。根据治疗方案分为低浓度TAC组和激素组。将其中尿蛋白定量>2 000 mg/24 h的患者也按上述方法分为两组。收集分析治疗前及治疗第1，3，6，12，18，24个月的临床资料并记录不良反应。结果：在尿蛋白定量>1 000 mg/24 h的患者中，TAC组于治疗第1个月尿蛋白定量显著下降；激素组在治疗第3个月显著下降(P<0.05)。在治疗第18，24个月TAC组尿蛋白定量下降值均高于激素组，差异有统计学意义(P<0.05)。在尿蛋白定量>2 000 mg/24 h患者中，TAC组在治疗各时间点尿蛋白定量均下降，与治疗前比较差异均有统计学意义(P<0.05)；激素组在治疗第1，3，6个月尿蛋白定量显著下降(P<0.05)，治疗第12至24个月与基线比较差异无统计学意义(P>0.05)。两种分组方法中，TAC组复发率均低于激素组(P<0.05)；总缓解率和完全缓解率上差异均无统计学意义(P>0.05)。两组不良反应方面差异无统计学意义(P>0.05)。结论：在特发性FSGS的治疗中，低浓度TAC联合激素的治疗方案对比单用激素显示出起效快、更强且持久稳定降尿蛋白的作用，是这类患者的更优选择。
关键词：
低浓度他克莫司；特发性局灶节段肾小球硬化；糖皮质激素
A retrospective controlled clinical study of low concentration of tacrolimus combined with prednisone in the treatment of idiopathic focal segmental glomerulosclerosis
CorrespondingAuthor: ZHAO Hongwen Email: zhaohw212@126.com
DOI: 10.3978/j.issn.2095-6959.2018.05.020
Foundation: This work was supported by the WU Jieping Medical Foundation Clinical Research Grant Fund, China (320.6750.16190).
Abstract
Objective: To explore the clinical efficacy and safety of low-concentration tacrolimus combined with glucocorticoids in the treatment of idiopathic focal segmental glomerulosclerosis (FSGS). Methods: Forty-one patients of idiopathic FSGS with urinary protein excretion exceeding 1 000 mg/24 h were included. According to the therapeutic regimen, patients were divided into a low-concentration TAC group and a hormone group. Further, patients with urinary protein excretion exceeding 2 000 mg/24 h were divided into two groups on the basis of the above method. The clinical data before treatment and 1, 3, 6, 12, 18, 24 months after treatment were collected and analysed, meanwhile, the adverse effects were also recorded. Results: In patients whose urinary protein excretion were greater than 1 000 mg/24 h, 24-hour urinary protein excretion was decreased significantly 1 month later in the TAC group , it began to decrease evidently 3 months later in hormone group (P<0.05). The reduction of 24-hour urinary protein excretion were more obvious in the TAC group at 18 and 24 months after treatment than the hormone group (P<0.05). In patients whose urinary protein excretion was much than 2 000 mg/24 h, 24-hour urinary protein excretion was decreased significantly at each time point after treatment in the TAC group (P<0.05). However, the indicator declined obviously at 1, 3, 6 months after treatment (P<0.05), no significant differences were seen at 12, 18, 24 months compared with values of baseline in the hormone group (P>0.05). Recurrence rate were lower significantly in the TAC group than the hormone group in both cases (P<0.05). The total effective rate and complete remission rate showed no significant differences between the two groups (P>0.05). There was no statistical difference in adverse reactions between the two groups (P>0.05). Conclusion: In the treatment of idiopathic FSGS, low-concentration TAC combined with glucocorticoid effected quickly, steadily, and was more effective in reduction of urinary protein excretion than the use of hormones, the therapeutic scheme was a better option for this population.
Keywords：
low-concentration tacrolimus; idiopathic focal segmental glomerulosclerosis; glucocorticoids