Cui W, Lu X, Min X, Liu M, Guan S, Wang Y, Luo M, Li W, Li Q, Dong W, Miao L, Luo P
Department of Nephrology, the Second Hospital of Jilin University, Jilin, China.
Department of Nephrology, Central Hospital of Jilin City, Jilin, China.
Braz J Med Biol Res. 2017 Mar 23;50(4):e5976. doi: 10.1590/1414-431X20175976.
We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4-8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.
我们评估了他克莫司（TAC）联合皮质类固醇治疗特发性膜性肾病（IMN）患者的疗效和安全性。在这项回顾性临床研究中招募了177例经活检证实的IMN患者。60例患者接受TAC治疗（目标血药浓度为4 - 8 ng/mL），117例患者接受每日环磷酰胺（CYC，100 mg）联合泼尼松治疗。TAC组在第1、2和3个月末的缓解率显著高于CYC组（第1个月：35.0%对19.7%，P<0.05；第2个月：56.7%对38.5%，P<0.05；第3个月：76.7%对59.0%，P<0.05）。在最初3个月，TAC组的每日尿蛋白和血清白蛋白改善情况优于CYC组（P<0.05）。在第6和12个月末，两组的缓解率、每日尿蛋白和血清白蛋白均无显著差异（P>0.05）。两组间复发率无显著差异（16.3%对12.0%，P>0.05）。TAC组患者更易发生葡萄糖不耐受。与CYC方案相比，TAC方案在治疗IMN患者方面，尤其是在最初3个月，获益更多。
