CAJ | 학술논문

目的：探讨他克莫司联合小剂量激素治疗 IgA 肾病的临床疗效。方法将收治的 IgA 肾病84例按照数字表法随机分为研究组和对照组，对照组给予单纯激素治疗，研究组采用他克莫司联合激素治疗，比较两组患者临床治疗的疗效及安全性差异。结果研究组患者的治疗有效率（100．00％）和完全缓解率（73．81％）均明显高于对照组[有效率为76．19％，完全缓解率为23．81％]，且差异均有统计学意义（χ2＝21．01、11．35，均 P ＜0．05）。两组患者治疗后24 h 尿蛋白水平均较本组治疗前明显下降，而在治疗后，研究组的24 h 尿蛋白水平[（0．54±0．41）g／L]较对照组治疗后[（1．06±0．62）g／L]亦明显下降，且差异均有统计学意义（t ＝4．01、4．58、3．87，均 P ＜0．05）。另外，两组患者治疗前后的血肌酐、血糖、白细胞、丙氨酸氨基转移酶、SBP 及 DBP 水平比较差异无统计学意义（P ＞0．05）。当患者病情较轻时（Lee 氏Ⅱ级），研究组治疗完全缓解率明显高于对照组，且差异有统计学意义（χ2＝5．01，P ＜0．05）。但是，随着病理损害加重（Lee 氏Ⅲ级～Ⅳ级），研究组和对照组患者的有效率和完全缓解率均呈现下降趋势，但是研究组的有效率和完全缓解率均高于对照组，但差异均无统计学意义（χ2＝1．03、2．11、1．20、1．20，均 P ＞0．05）。研究组的不良反应发生率（19．05％）与对照组（16．67％）相比差异无统计学意义（χ2＝0．08，P ＞0．05）。结论他克莫司联合小剂量激素对于 IgA 肾病的治疗具有较高的临床应用价值，可以显著降低 IgA 肾病的24 h 尿蛋白水平，并且不良反应少。
목적：탐토타극막사연합소제량격소치료 IgA 신병적림상료효。방법장수치적 IgA 신병84례안조수자표법수궤분위연구조화대조조，대조조급여단순격소치료，연구조채용타극막사연합격소치료，비교량조환자림상치료적료효급안전성차이。결과연구조환자적치료유효솔（100．00％）화완전완해솔（73．81％）균명현고우대조조[유효솔위76．19％，완전완해솔위23．81％]，차차이균유통계학의의（χ2＝21．01、11．35，균 P ＜0．05）。량조환자치료후24 h 뇨단백수평균교본조치료전명현하강，이재치료후，연구조적24 h 뇨단백수평[（0．54±0．41）g／L]교대조조치료후[（1．06±0．62）g／L]역명현하강，차차이균유통계학의의（t ＝4．01、4．58、3．87，균 P ＜0．05）。령외，량조환자치료전후적혈기항、혈당、백세포、병안산안기전이매、SBP 급 DBP 수평비교차이무통계학의의（P ＞0．05）。당환자병정교경시（Lee 씨Ⅱ급），연구조치료완전완해솔명현고우대조조，차차이유통계학의의（χ2＝5．01，P ＜0．05）。단시，수착병리손해가중（Lee 씨Ⅲ급～Ⅳ급），연구조화대조조환자적유효솔화완전완해솔균정현하강추세，단시연구조적유효솔화완전완해솔균고우대조조，단차이균무통계학의의（χ2＝1．03、2．11、1．20、1．20，균 P ＞0．05）。연구조적불량반응발생솔（19．05％）여대조조（16．67％）상비차이무통계학의의（χ2＝0．08，P ＞0．05）。결론타극막사연합소제량격소대우 IgA 신병적치료구유교고적림상응용개치，가이현저강저 IgA 신병적24 h 뇨단백수평，병차불량반응소。
Objective To study the clinical effect of tacrolimus combined with small dose of prednisolone in treatment of IgA nephropathy.Methods 84 cases with IgA nephropathy were randomly divided into study group and the control group in accordance with the digital table method.The control group was given simple hormone treatment, while the study group was treated with tacrolimus combined with small dose of prednisolone.The clinical efficacy and safety were compared between the two groups.Results The treatment effective rate (100.00%)and complete remis-sion rate (73.81%)of the study group were significantly higher than those in the control group (76.19%, 23.81%),and the differences were statistically significant (χ2 =21.01,11.35,P <0.05 ).After treatment,24h urinary protein level was significantly decreased compared with before treatment.24h urinary protein level[(0.54 ± 0.41)g/L]of the study group was significantly lower than the control group[(1.06 ±0.62)g/L],and the difference was statistically significant (t =4.01,4.58,3.87,all P <0.05).In addition,before and after treatment,the serum creatinine,blood sugar,white blood cells,cereal third transaminase,SBP and DBP levels between two groups had no significant differences (P >0.05).When patients lighter (Lee's Ⅱ level),the team for complete response rate was significantly higher than the control group,and the difference was statistically significant (χ2 =5.01,P <0.05 ). However,with the aggravation of pathological damage (Lee),the effective rate and complete remission rate of the study group and the control group showed a downward trend.The effective rate and complete remission rate of the study group were higher than those in the control group,but the differences were not statistically significant (χ2 =1.03,2.11,1.20,1.20,all P >0.05).The incidence rate of adverse reactions in the study group (19.05%)was not significantly different from that of the control group (16.67%)(χ2 =0.08,P >0.05 ).Conclusion Tacrolimus combined with small dose hormone for the treatment of IgA nephropathy has high clinical value,it can significantly reduce the level of IgA nephropathy 24h nephropathy,and adverse reactions.