他克莫司治疗难治性肾病综合征临床疗效

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1、他克莫司治疗难治性肾病综合征临床疗效蓝天座于黔闵亚丽蒋文勇吴欣翟晓江黄健(贵阳市第一人民医院肾内科贵州贵阳550002)【】R692【】A【】1672-5085(2012)20-0162-03【】目的探讨他克莫司联合糖皮质激素治疗难治性肾病综合征(RNS)的临床疗效及安全性。方法24例RNS患者随机分为治疗组(12例)和对照组(12例)，在糖皮质激素治疗的基础上，两组分別加用他克莫司和环磷酰胺，持续12个月。对比观察两组的临床疗效，生化指标变化及药物不良反应。结果两组治疗后24小时尿蛋白定量、血

2、胆固醇和甘油三酯水平明显下降，血浆白蛋白水平显著升高，与治疗前比较差异有显著性(p<0.05);两组间比较，治疗组24小时尿蛋白定量和血浆白蛋白水平变化更为明显，差异有显著性(p<0.05);治疗组总有效率为92%,对照组总有效率为83%，组间比较差异无显著性(p〉0.05)。用药期间治疗组总不良反应发生率为17%,明显低于对照组42%,差异有显著性(p<0.05)。结论他克莫司联合糖皮质激素治疗RNS兵有较好疗效，耐受性好，不良反应轻，但长期疗效及不良反应仍需进一步观察。【关

3、键词】难治性肾病综合征他克莫司临床疗效【Abstract】ObjectiveToexploretheclinicalefficiencyandsafetyofTacrolimuscombinedwithglucocorticoidforthetreatmentofrefractorynephroticsyndrome.MethodsTotally24patientswithrefractorynephroticsyndromewererandomlydividedintoobservationg

4、roup(n=12)andcontrolgroup(n=12).AIIpatientsreceivedTacrolimusandCyclophosphamiderespectivelyonthebasisofsteroidtherapyandsustainedfor12months.Theclinicalefficacy,thechangeofbiochemicalindicatorsanddrugadversereactionswereobservedandcomparedbetweentwo

5、groups.ResultsAftertreatment,24hoursurineproteinquantity,triglycerideandcholesterollevelsofbothgroupsdecreasedsignificantly,whileserumalbuminlevelincreasedobviousely,andtherewassignificantdifferencebetweenbeforeandaftertreatment(p<0.05).The24hurin

6、eproteinandalbuminlevelsinobservationgroupchangedmoreobviouslythanthoseincontrolgroup,andtherewassignificantdifferencebetweentwogroups(p<0.05).Thetotaleffectiverateofobservationgroupandcontrolgroupwas92%and83%,respectively,buttherewasnosignificant

7、differencebetweentwogroups(p>0.05).Thetotalincidencerateofadversereactionsofobservationgroupandcontrolgroupwas17%and42%,respectively,andtherewassignificantdifferencebetweentwogroups(p<0.05).ConclusionTacrolimuscombinedwithglucocorticoidforthetr

8、eatmentofrefractorynephroticsyndromehasgoodeffectandtolerancewithlessadversereactions,butthelong-termcurativeeffectandadversereactionsneedfurtherobserving.【Keywords】RefractorynephroticsydromeTacrolimusClinicalefficacy0前，国内外尚无关于难治性肾病综合征一致定义，一般认为，难治性肾病