Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Sci Rep. 2024 Jun 20;14(1):14214. doi: 10.1038/s41598-024-64661-w.
Previous studies showed tacrolimus monotherapy and dual therapy with tacrolimus and prednisone as effective treatment modalities in managing membranous nephropathy. However, few studies have compared these therapeutic regimens. The patients were divided into two groups based on the treatment regimen: (1) tacrolimus and prednisone dual therapy (T + P group, n = 67) treatment group; and (2) tacrolimus monotherapy (T group, n = 65) or the control group. Propensity matching method and subgroup analysis to eliminate the bias in the relationship between the treatment regimen and the outcomes. The mean remission times were 20.33 ± 2.75 weeks at T group and 9.50 ± 1.81 weeks at T + P group. The T group had a remission rates of 73.33, 76.66 and 66.66% at 12weeks, 24weeks and 48weeks, while the T + P group had a remission rate of 81.66, 86.66, 91.66%; At the follow-up of 48 weeks, the relapse rate for the T group was 21.66%, and that for the T + P group was 5%. The anti-PLA2R ab is positive and therapy may be the independent risk factors for predicting remission. Tacrolimus and low-dose prednisone dual therapy is efficacious in managing MN and lowers the recurrence rate in clinical practice.
先前的研究表明，他克莫司单药治疗和他克莫司与泼尼松联合治疗是治疗膜性肾病的有效治疗方法。然而，很少有研究比较这些治疗方案。根据治疗方案将患者分为两组：（1）他克莫司和泼尼松联合治疗（T+P 组，n=67）治疗组；（2）他克莫司单药治疗（T 组，n=65）或对照组。采用倾向性匹配方法和亚组分析消除治疗方案与结局之间的关系偏倚。T 组的平均缓解时间为 20.33±2.75 周，T+P 组为 9.50±1.81 周。T 组在 12 周、24 周和 48 周时的缓解率分别为 73.33%、76.66%和 66.66%，而 T+P 组的缓解率分别为 81.66%、86.66%和 91.66%；在 48 周的随访中，T 组的复发率为 21.66%，T+P 组的复发率为 5%。抗 PLA2R ab 阳性和治疗可能是预测缓解的独立危险因素。他克莫司联合小剂量泼尼松联合治疗对 MN 有效，可降低临床复发率。
