他克莫司联合激素治疗原发性肾病综合征疗效分析-现代医学

他克莫司联合激素治疗原发性肾病综合征疗效分析

单位：东南大学附属中大医院肾脏科, 江苏南京 210009

分类号：R692

出版年·卷·期（页码）：2018·46·第六期（695-699）

摘要：

目的：探讨他克莫司联合糖皮质激素治疗原发性肾病综合征的疗效、疗效相关因素，以及治疗过程中不良事件的发生情况。方法：收集使用他克莫司联合糖皮质激素治疗的原发性肾病综合征患者62例的临床资料，观察疗效，分析疗效相关因素及不良事件发生率。结果：经治疗部分缓解者21例（33.9%），完全缓解者20例（32.2%）；用药前天门冬氨酸氨基转移酶（AST）水平（OR 1.193，95% CI 1.041~1.368，P=0.011）为缓解的相关因素，他克莫司血药浓度（OR 1.492，95% CI 1.025~2.173，P=0.037）以及是否伴有血尿（OR 0.173，95% CI 0.04~0.737，P=0.018）是完全缓解的相关因素；IgM肾病患者在治疗后均获得缓解；肝功能损伤、肾功能损伤、糖尿病、感染的发生率分别为19%、16%、16%和18%。结论：激素联合他克莫司治疗原发性肾病综合征临床缓解率高，主要副作用为肝肾功能损伤、血糖增高和感染。

Objective:To analyze the efficacy and influential factors of tacrolimus combined with glucocorticoids in the treatment of primary nephrotic syndrome. Methods:62 cases of primary nephrotic syndrome treated with tacrolimus combined with glucocorticoids were collected. The efficacy, the related influencial factors and the adverse events were evaluated. Results:21 cases(33.9%) were partially remitted and 20 cases(32.2%) were completely remitted. The level of aspartate transaminase(AST) (OR 1.193, 95% CI 1.041-1.368, P=0.011) before medication was the related factor of remission. Tacrolimus concentration(OR 1.492, 95% CI 1.025-2.173,P=0.037), and whether hematuria or not (OR 0.173, 95% CI 0.04-0.737,P=0.018) before medication were related factors for complete remission. All the patients with IgM nephropathy were relieved after treatment. In the treatment process, the incidence rate of the liver function injury,renal function injury, diabetes and infection were 19%,16%,16% and 18%. Conclusion:There is a high clinical remission rate after the treatment of tacrolimus combined with glucocorticoids in primary nephrotic syndrome. The main side effects of tacrolimus combined with glucocorticoids are the liver function injury,renal function injury, diabetes and infection.

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