中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
1期
1-6
,共6页
万静芳%卢晓梅%唐雪莲%李开斌%林利容%何娅妮%李开龙
萬靜芳%盧曉梅%唐雪蓮%李開斌%林利容%何婭妮%李開龍
만정방%로효매%당설련%리개빈%림리용%하아니%리개룡
他罗利姆%糖皮质激素类%肝炎病毒,乙型%肾小球肾炎,膜性%恩替卡韦
他囉利姆%糖皮質激素類%肝炎病毒,乙型%腎小毬腎炎,膜性%恩替卡韋
타라리모%당피질격소류%간염병독,을형%신소구신염,막성%은체잡위
Tacrolimus%Glucocorticoids%Hepatitis B virus%Glomerulonephritis,membranous%Entecavir
目的 进行前瞻性、随机、对照临床试验,评估他克莫司联合恩替卡韦和小剂量糖皮质激素治疗乙型肝炎病毒相关性膜性肾病(Hepatitis B virus-associated membrane nephropathy,HBV-MN)的临床疗效.方法 入组患者38例,按随机数字表法分为试验组19例和对照组19例,试验组给予他克莫司(0.05 mg· kg-1·d-1)、小剂量激素(醋酸泼尼松,0.5 mg·kg-1·d-1)及恩替卡韦(0.5 mg/d)联合治疗,对照组接受恩替卡韦(0.5 mg/d)单一疗法,以完全缓解率及部分缓解率来评估患者疗效.结果 在治疗第6个月及12个月试验组总缓解率分别为88.89％、94.44％,但在对照组仅38.89％、58.82％,试验组观察到尿蛋白缓解更加明显.恩替卡韦可减少乙型肝炎病毒DNA(HBV-DNA)滴度,在治疗第3个月,入组患者肝功能均恢复正常.试验组有1例、对照组有2例因达到次要终点而退出本次试验.试验组有1例在他克莫司减量过程中尿蛋白复发.结论 他克莫司联合恩替卡韦和小剂量糖皮质激素治疗HBV-MN,能显著降低蛋白尿、保护肾功能,并能控制HBV-DNA的复制,是HBV-MN有效的治疗模式之一.
目的 進行前瞻性、隨機、對照臨床試驗,評估他剋莫司聯閤恩替卡韋和小劑量糖皮質激素治療乙型肝炎病毒相關性膜性腎病(Hepatitis B virus-associated membrane nephropathy,HBV-MN)的臨床療效.方法 入組患者38例,按隨機數字錶法分為試驗組19例和對照組19例,試驗組給予他剋莫司(0.05 mg· kg-1·d-1)、小劑量激素(醋痠潑尼鬆,0.5 mg·kg-1·d-1)及恩替卡韋(0.5 mg/d)聯閤治療,對照組接受恩替卡韋(0.5 mg/d)單一療法,以完全緩解率及部分緩解率來評估患者療效.結果 在治療第6箇月及12箇月試驗組總緩解率分彆為88.89％、94.44％,但在對照組僅38.89％、58.82％,試驗組觀察到尿蛋白緩解更加明顯.恩替卡韋可減少乙型肝炎病毒DNA(HBV-DNA)滴度,在治療第3箇月,入組患者肝功能均恢複正常.試驗組有1例、對照組有2例因達到次要終點而退齣本次試驗.試驗組有1例在他剋莫司減量過程中尿蛋白複髮.結論 他剋莫司聯閤恩替卡韋和小劑量糖皮質激素治療HBV-MN,能顯著降低蛋白尿、保護腎功能,併能控製HBV-DNA的複製,是HBV-MN有效的治療模式之一.
목적 진행전첨성、수궤、대조림상시험,평고타극막사연합은체잡위화소제량당피질격소치료을형간염병독상관성막성신병(Hepatitis B virus-associated membrane nephropathy,HBV-MN)적림상료효.방법 입조환자38례,안수궤수자표법분위시험조19례화대조조19례,시험조급여타극막사(0.05 mg· kg-1·d-1)、소제량격소(작산발니송,0.5 mg·kg-1·d-1)급은체잡위(0.5 mg/d)연합치료,대조조접수은체잡위(0.5 mg/d)단일요법,이완전완해솔급부분완해솔래평고환자료효.결과 재치료제6개월급12개월시험조총완해솔분별위88.89％、94.44％,단재대조조부38.89％、58.82％,시험조관찰도뇨단백완해경가명현.은체잡위가감소을형간염병독DNA(HBV-DNA)적도,재치료제3개월,입조환자간공능균회복정상.시험조유1례、대조조유2례인체도차요종점이퇴출본차시험.시험조유1례재타극막사감량과정중뇨단백복발.결론 타극막사연합은체잡위화소제량당피질격소치료HBV-MN,능현저강저단백뇨、보호신공능,병능공제HBV-DNA적복제,시HBV-MN유효적치료모식지일.
Objective To conduct a prospective,randomly controlled trial,evaluating the combination of tacrolimus,corticosteroids and entecavir for the treatment of adult patients with biopsyproven hepatitis B virus-associated membrane nephropathy (HBV-MN).Methods A total of 38 patients with biopsy-confirmed HBV-MN were randomized to the tacrolimus group (n=19) and the control group (n=19).Patients in tacrolimus group received combination therapy of tacrolimus (0.05 mg·kg-1 · d-1),corticosteroids (prednisone acetate,0.5 mg· kg-1 · d-1) and entecavir (0.5 mg/d),whereas patients in control group received entecavir mono-therapy (0.5 mg/d).The primary end point was the percentage of patients reaching complete remission (CR) or partial remission (PR).Results The probability of remission in the treatment group was 88.89％ and 94.44％ after 6 and 12 months,but only 38.89％ and 58.82％ in the control group,respectively.The decrease in proteinuria was significantly greater in the treatment group.Entecavir was used for the treatment of hepatitis in all patients,which caused the disappearance of serum hepatitis B viral DNA(HBV-DNA) and the normalization of ALT and AST levels in 3 months.Notably,two patients in the control group and one patient in the treatment group reached the secondary end point.One patient in the tacrolimus-treated group showed a relapse during the taper period.Conclusion This treatment protocol not only can control the replication of HBV-DNA but also can reduce proteinuria and preserve renal function,it is one of useful therapeutic options for patients with HBV-MN.
