他克莫司在肾病综合征治疗中的作用研究
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摘要
目的探讨他克莫司在肾病综合征治疗中的作用。方法选取本院2016年1月至2018年1月收治的100例肾病综合征患者为研究对象,采用随机数表法将其分为观察组(50例)和对照组(50例),两组患者均口服醋酸泼尼松片和环磷酰胺片,观察组患者在此基础上加用他克莫司胶囊治疗,两组患者均连续治疗3个月。比较两组患者治疗前后肾功能指标[24 h蛋白尿定量(24 h urine protein,24hPro),血尿素氮(blood urea nitrogen,BUN)]、常规生化指标[甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、空腹血糖(fasting plasma glucose,FPG)]、炎性因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-1(interleukin-1,IL-1),白介素-6(interleukin-6,IL-6)]水平、治疗效果及不良反应发生情况。结果治疗后,两组患者BUN、24h Pro、TG、TC、FPG、TNF-α、IL-1及IL-6水平均显著低于本组治疗前(均P <0.05),且观察组患者上述指标水平均显著低于同期对照组(均P <0.05)。观察组患者有效率显著高于对照组(P <0.05),两组患者治疗期间不良反应发生率比较无显著差异(P> 0.05)。结论他克莫司联合小剂量糖皮质激素能够减少肾病综合征患者蛋白尿和炎性反应,并可调节血脂。
Objective To explore the clinical efficacy of Tacrolimus combined with low-dose Glucocorticoid in the treatment of nephrotic syndrome. Method 100 patients with nephrotic syndrome admitted to our hospital from January 2016 to January 2018 were selected for the study and divided into observation group(50 cases) and control group(50 cases) according to the random number table method. The two groups patients were orally administered with Prednisone acetate tablets + Cyclophosphamide tablets,and observation group patients were given Tacrolimus capsules on this basis, and the two groups patients were treated continuously for3 months. The levels of renal function indicators [24 h urine protein(24 hPro), blood urea nitrogen(BUN)], conventional biochemical indicators [triglyceride(TG), total cholesterol(TC), fasting plasma glucose(FPG)] and inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-1(IL-1) and interleukin-6(IL-6)] before and after treatment, treatment effects and occurrence of adverse reactions were compared between the two groups. Result After treatment, the levels of BUN, 24 hPro, TG, TC, FPG, TNF-α, IL-1 and IL-6 in the two groups were significantly lower than those before treatment(all P < 0.05), and the levels of above indexes in observation group were significantly lower than those in control group(all P < 0.05). The effective rate in observation group was significantly higher than that in control group(P < 0.05), and there was no significant difference in the incidence rate of adverse reactions during treatment between the two groups(P > 0.05). Conclusion Tacrolimus combined with low-dose Glucocorticoid can reduce proteinuria and inflammatory response and regulate blood lipids of patients with nephrotic syndrome.
Objective To explore the clinical efficacy of Tacrolimus combined with low-dose Glucocorticoid in the treatment of nephrotic syndrome. Method 100 patients with nephrotic syndrome admitted to our hospital from January 2016 to January 2018 were selected for the study and divided into observation group(50 cases) and control group(50 cases) according to the random number table method. The two groups patients were orally administered with Prednisone acetate tablets + Cyclophosphamide tablets,and observation group patients were given Tacrolimus capsules on this basis, and the two groups patients were treated continuously for3 months. The levels of renal function indicators [24 h urine protein(24 hPro), blood urea nitrogen(BUN)], conventional biochemical indicators [triglyceride(TG), total cholesterol(TC), fasting plasma glucose(FPG)] and inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-1(IL-1) and interleukin-6(IL-6)] before and after treatment, treatment effects and occurrence of adverse reactions were compared between the two groups. Result After treatment, the levels of BUN, 24 hPro, TG, TC, FPG, TNF-α, IL-1 and IL-6 in the two groups were significantly lower than those before treatment(all P < 0.05), and the levels of above indexes in observation group were significantly lower than those in control group(all P < 0.05). The effective rate in observation group was significantly higher than that in control group(P < 0.05), and there was no significant difference in the incidence rate of adverse reactions during treatment between the two groups(P > 0.05). Conclusion Tacrolimus combined with low-dose Glucocorticoid can reduce proteinuria and inflammatory response and regulate blood lipids of patients with nephrotic syndrome.
引文
[1]杨新军,汪晶华,陈云爽,等.老年肾病综合征202例临床分析[J].临床误诊误治,2016,29(11):89-92.
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[8]张咏赞,张翠欣.他克莫司药理作用及临床疗效的研究进展[J].中国医院药学杂志,2016,36(3):241-244.
[9]黄茂,王俐,鲁志力,等.小剂量低分子肝素钠联合糖皮质激素治疗儿童原发性肾病综合征临床疗效分析[J].儿科药学杂志,2017,14(6):22-25.
[10]邓舜天,杨玉仙,戴德竟,等.醋酸泼尼松和环磷酰胺冲击疗法联合雷公藤多苷治疗肾病综合征的疗效观察[J].中国临床研究,2017,30(5):631-634.
[11]陈波,邱敏,荣冬靖.他克莫司联合糖皮质激素治疗成人难治性肾病综合征的临床效果评估[J].中国医学前沿杂志(电子版),2016,8(11):68-71.
[12]郭向华,魏蔚,李健,等.他克莫司与环磷酰胺治疗狼疮性肾炎临床效果比较分析[J].中国医学前沿杂志(电子版),2015,7(9):128-130.
[13]张建珍,郭玮,张俊芳.强脉冲光或他克莫司软膏联合透明质酸修护生物膜治疗面部激素依赖性皮炎的临床效果比较[J].中国医学前沿杂志(电子版),2017,9(6):91-95.
[14]钱阳晶.防己黄芪汤联合通因通用法治疗脾虚湿困型原发性肾病综合征疗效及对血清IL-8和IL-13水平的影响[J].现代中西医结合杂志,2017,26(20):2217-2219.
[15]孙启昌,赵洪雯,李丽娜,等.小剂量他克莫司联合糖皮质激素对中等量蛋白尿IgA肾病的临床疗效回顾[J].第三军医大学学报,2017,39(5):481-486.
[16]谢清科,于力,于生友,等.他克莫司稳定肾小球足细胞podocin蛋白表达分布进而抑制嘌呤霉素引起的足细胞损伤[J].中华实用儿科临床杂志,2018,33(5):347-352.
[17]陈卫红,曹斌.健脾祛湿中药联合激素冲击疗法治疗复发性肾病综合征疗效及对炎性细胞因子、纤溶指标的影响[J].现代中西医结合杂志,2017,26(35):3929-3932.
[18]袁芳,吴秀芝.他克莫司的不良反应与临床药学监护要点[J].解放军预防医学杂志,2016,34(6):938-940.
[2]李永珍,何庆南.原发性肾病综合征免疫发病机制研究进展[J].国际儿科学杂志,2016,43(1):51-55.
[3]中华医学会儿科学分会肾脏学组.激素耐药型肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(11):805-809.
[4]张景秀,张立明.他克莫司联合糖皮质激素治疗儿童难治性肾病综合征[J].儿科药学杂志,2017(10):16-19.
[5]唐杰.他克莫司联合糖皮质激素治疗肾病综合征的疗效及对炎症因子的影响[J].医学临床研究,2017,34(4):685-687.
[6]中国成人肾病综合征免疫抑制治疗专家组.中国成人肾病综合征免疫抑制治疗专家共识[J].中华肾脏病杂志,2014,30(6):467-474.
[7]孙宏伟,刘云霞,刘胜阳.低分子肝素治疗对肾病综合征患者凝血指标、生化指标及临床疗效的影响[J].实用临床医药杂志,2017,21(3):32-34.
[8]张咏赞,张翠欣.他克莫司药理作用及临床疗效的研究进展[J].中国医院药学杂志,2016,36(3):241-244.
[9]黄茂,王俐,鲁志力,等.小剂量低分子肝素钠联合糖皮质激素治疗儿童原发性肾病综合征临床疗效分析[J].儿科药学杂志,2017,14(6):22-25.
[10]邓舜天,杨玉仙,戴德竟,等.醋酸泼尼松和环磷酰胺冲击疗法联合雷公藤多苷治疗肾病综合征的疗效观察[J].中国临床研究,2017,30(5):631-634.
[11]陈波,邱敏,荣冬靖.他克莫司联合糖皮质激素治疗成人难治性肾病综合征的临床效果评估[J].中国医学前沿杂志(电子版),2016,8(11):68-71.
[12]郭向华,魏蔚,李健,等.他克莫司与环磷酰胺治疗狼疮性肾炎临床效果比较分析[J].中国医学前沿杂志(电子版),2015,7(9):128-130.
[13]张建珍,郭玮,张俊芳.强脉冲光或他克莫司软膏联合透明质酸修护生物膜治疗面部激素依赖性皮炎的临床效果比较[J].中国医学前沿杂志(电子版),2017,9(6):91-95.
[14]钱阳晶.防己黄芪汤联合通因通用法治疗脾虚湿困型原发性肾病综合征疗效及对血清IL-8和IL-13水平的影响[J].现代中西医结合杂志,2017,26(20):2217-2219.
[15]孙启昌,赵洪雯,李丽娜,等.小剂量他克莫司联合糖皮质激素对中等量蛋白尿IgA肾病的临床疗效回顾[J].第三军医大学学报,2017,39(5):481-486.
[16]谢清科,于力,于生友,等.他克莫司稳定肾小球足细胞podocin蛋白表达分布进而抑制嘌呤霉素引起的足细胞损伤[J].中华实用儿科临床杂志,2018,33(5):347-352.
[17]陈卫红,曹斌.健脾祛湿中药联合激素冲击疗法治疗复发性肾病综合征疗效及对炎性细胞因子、纤溶指标的影响[J].现代中西医结合杂志,2017,26(35):3929-3932.
[18]袁芳,吴秀芝.他克莫司的不良反应与临床药学监护要点[J].解放军预防医学杂志,2016,34(6):938-940.