糖皮质激素联合他克莫司、吗替麦考酚酯多靶点治疗难治性膜性肾病的疗效分析及不良反应

Efficacy and adverse reactions of glucocorticoid combined with tacrolimus and mycophenolate mofetil in multi-target treatment of refractory membranous nephropathy

摘要:

目的 探讨糖皮质激素联合他克莫司、吗替麦考酚酯多靶点治疗难治性膜性肾病（MN）的疗效及不良反应。方法 选取2020年1月—2020年12月江苏省人民医院收治的94例难治性MN患者，以随机数表法分为对照组和研究组，每组47例。对照组口服醋酸泼尼松片及他克莫司胶囊，研究组在对照组基础上口服吗替麦考酚酯，两组持续治疗6个月后观察效果。比较两组临床疗效、肾功能、肾足细胞损伤、氧化应激、肝功能及药物不良反应发生情况。自治疗起始随访2年，统计并比较两组复发情况。结果 治疗期间共脱落3例。研究组总有效率高于对照组（P <0.05）。研究组治疗前后白蛋白、总蛋白、血肌酐、24 h尿蛋白、Podocalyxin、Nephrin、晚期蛋白氧化产物、活性氧簇、超氧化物歧化酶的差值高于对照组（P <0.05）。两组治疗前后丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素的差值比较，差异均无统计学意义（P >0.05）。两组总药物不良反应发生率比较，差异无统计学意义（P >0.05）。研究组复发率低于对照组（P <0.05）。结论 糖皮质激素联合他克莫司、吗替麦考酚酯多靶点免疫抑制治疗难治性MN可改善近远期疗效，改善患者肾功能及肾足细胞损伤，抑制氧化应激损伤，且安全性良好。

Abstract:

Objective To investigate the efficacy and adverse reactions of glucocorticoid combined with tacrolimus and mycophenolate mofetil in the multi-target treatment of refractory membranous nephropathy (MN).Methods Ninety-four patients with refractory MN admitted to Jiangsu Province Hospital from January 2020 to December 2020 were selected and divided into control group and study group via random number table method, with 47 cases in each group. The control group was given prednisone acetate tablets and tacrolimus capsules, and the study group was additionally given mycophenolate mofetil. The therapeutic effect was observed after 6 months of continuous treatment in both groups. The clinical efficacy, renal function, renal podocyte injury, oxidative stress, liver function and the occurrence of adverse drug reactions were compared between the two groups. The patients in the two groups were followed up for 2 years since the initiation of treatment, and recurrence of the disease was analyzed and compared between the two groups.Results Three cases were lost to follow-up during the treatment. The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of levels of albumin (Alb), total protein (TP), serum creatinine (Scr), 24-hour urine protein (24 hUpro), podocalyxin and nephrin, advanced protein oxidation products (AOPP), reactive oxygen species (ROS) and superoxide dismutase (SOD) before and after the treatment in the study group were higher than those in the control group (P < 0.05). The differences of levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) before and after treatment were not different between the two groups (P > 0.05). There was no significant difference in the overall incidence of adverse drug reactions between the two groups (P > 0.05). The recurrence rate in the study group was lower than that in the control group (P < 0.05).Conclusions Glucocorticoid combined with tacrolimus and mycophenolate mofetil as the multi-target immunosuppressive treatment of refractory MN may enhance short-term and long-term therapeutic efficacy, improve renal function and renal podocyte injury, and inhibit oxidative stress injury with good safety.