CAJ | 학술논문

目的：探讨钙调神经磷酸酶抑制剂对首诊特发性膜性肾病(idiopathic membranous ne-phropathy,IMN)和难治性 IMN患者的有效性。方法回顾性分析第二军医大学长征医院肾内科确诊并常规随访的 IMN患者72例,其中33例为经血管紧张素转换酶抑制剂(angiotension conversion enzyme inhibitor,ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB)等保守治疗6个月未缓解的首诊 IMN患者,39例为经环磷酰胺治疗6个月未缓解的难治性 IMN 患者。门诊定期随访其患者24 h尿蛋白定量、血白蛋白、血肌酐、尿素氮、尿酸、血胆固醇、三酰甘油、环孢素 A(cyclos-porine A,CsA)和他克莫司(tacrolimus,FK-506)浓度等指标,分析其对钙调神经磷酸酶抑制剂的治疗反应并对患者的缓解率及复发率进行观察。随访时间为6~12个月。结果首诊 IMN 患者中,CsA组治疗后第3、6及12个月时,24 h尿蛋白定量(F=36.36,P<0.0001)、血白蛋白水平(F=20.81,P<0.0001)、血总胆固醇(F=15.35,P=0.0015)分别较治疗前明显好转；FK-506组治疗后第3、6及12个月时,24 h尿蛋白定量(F=40.06,P<0.01)、血白蛋白水平(F=34.42,P<0.0001)、血总胆固醇(F=23.15,P<0.0001)分别较治疗前也明显好转。难治性 IMN患者中,CsA 组治疗后第3、6及12个月时,24 h尿蛋白定量(F=46.6,P<0.0001)和血白蛋白(F=25.57,P<0.0001)分别明显好转；FK-506组治疗后第3、6及12个月时,24 h尿蛋白定量(F=51.5,P<0.0001)和血白蛋白(F=31.62,P<0.0001)亦分别明显好转。缓解率随治疗时间延长而增长,但环孢素 A 及他克莫司在肾病缓解方面的差异无统计学意义(P>0.05)。结论钙调神经磷酸酶抑制剂联合小剂量激素不仅对首诊 IMN有效,对环磷酰胺无效的难治性 IMN仍有效,且两类钙调神经磷酸酶抑制剂在治疗效果方面差异无统计学意义,不良反应发生率较低且可调控。
목적：탐토개조신경린산매억제제대수진특발성막성신병(idiopathic membranous ne-phropathy,IMN)화난치성 IMN환자적유효성。방법회고성분석제이군의대학장정의원신내과학진병상규수방적 IMN환자72례,기중33례위경혈관긴장소전환매억제제(angiotension conversion enzyme inhibitor,ACEI)혹혈관긴장소수체길항제(angiotensin receptor blocker,ARB)등보수치료6개월미완해적수진 IMN환자,39례위경배린선알치료6개월미완해적난치성 IMN 환자。문진정기수방기환자24 h뇨단백정량、혈백단백、혈기항、뇨소담、뇨산、혈담고순、삼선감유、배포소 A(cyclos-porine A,CsA)화타극막사(tacrolimus,FK-506)농도등지표,분석기대개조신경린산매억제제적치료반응병대환자적완해솔급복발솔진행관찰。수방시간위6~12개월。결과수진 IMN 환자중,CsA조치료후제3、6급12개월시,24 h뇨단백정량(F=36.36,P<0.0001)、혈백단백수평(F=20.81,P<0.0001)、혈총담고순(F=15.35,P=0.0015)분별교치료전명현호전；FK-506조치료후제3、6급12개월시,24 h뇨단백정량(F=40.06,P<0.01)、혈백단백수평(F=34.42,P<0.0001)、혈총담고순(F=23.15,P<0.0001)분별교치료전야명현호전。난치성 IMN환자중,CsA 조치료후제3、6급12개월시,24 h뇨단백정량(F=46.6,P<0.0001)화혈백단백(F=25.57,P<0.0001)분별명현호전；FK-506조치료후제3、6급12개월시,24 h뇨단백정량(F=51.5,P<0.0001)화혈백단백(F=31.62,P<0.0001)역분별명현호전。완해솔수치료시간연장이증장,단배포소 A 급타극막사재신병완해방면적차이무통계학의의(P>0.05)。결론개조신경린산매억제제연합소제량격소불부대수진 IMN유효,대배린선알무효적난치성 IMN잉유효,차량류개조신경린산매억제제재치료효과방면차이무통계학의의,불량반응발생솔교저차가조공。
Objective To observe the efficacy of calcineurin inhibitors in the treatment of the simple and the refractory idiopathic membranous nephropathy.Methods Seventy-two patients with id-iopathic membranous nephropathy and regularly followed up in Changzheng Hospital of the Second Military Medical University were enrolled.There were 33 patients without remission after 6 months of angiotension conversion enzyme inhibitor or angiotensin receptor blocker,and 39 patients without re-mission after 6 months of cyclophosphamiddum.These outpatients were regularly followed up with 24-h urinary protein,plasma albumin,serum creatinine,blood urea nitrogen,uric acid,cholesterol,tri-glyceride and blood concentration of calcineurin inhibitors.The therapeutic response of calcineurin in-hibitors and the remission and recurrence rate of idiopathic membranous nephropathy were observed. The follow-up duration was 6 to 12 months.Results Of the 33 patients who received first immunosup-pressive treatment,the cyclosporine A group had significant remission of 24-h urinary protein (F=36.36,P<0.000 1),plasma albumin (F=20.81,P<0.000 1)and plasma cholesterol (F=15.35, P=0.001 5),and the tacrolimus group also had significant remission of 24-h urinary protein (F=40.06,P<0.01),plasma albumin (F=34.42,P<0.000 1)and plasma cholesterol (F=23.15,P<0.000 1).Of the 39 patients who have received cyclophosphamiddum treatment,the cyclosporine A group had significant remission of 24-h urinary protein (F=46.6,P<0.000 1 )and plasma albumin (F=25.57,P<0.000 1),and the tacrolimus group also had significant remission of 24-h urinary protein (F=51.5,P<0.000 1)and plasma albumin (F=31.62,P<0.000 1).The remission rate was increased with time,but no significant difference was found between the two groups (P>0.05). Conclusions The calcineurin inhibitors combined with low-dose prednisolone treatment can be effec-tive for either the simple idiopathic membranous nephropathy or the refractory idiopathic membranous nephropathy.The difference between the two kinds of calcineurin inhibitors has no statistically signifi-cant difference.The adverse reaction can be low-graded and regulated.