他克莫司或来氟米特联合泼尼松治疗特发性膜性肾病的疗效及安全性对比

目的 观察对比他克莫司或来氟米特联合泼尼松治疗特发性膜性肾病的疗效及安全性。方法 选取在榆林市第二医院就诊的经肾活检诊断为膜性肾病的80例患者，随机分为观察组（他克莫司+泼尼松）和对照组（来氟米特+泼尼松）各40例。对比两组治疗前后血清白蛋白、血糖、24 h尿蛋白定量、血清胆固醇、血清三酰甘油及血肌酐变化。结果 观察组完全缓解和部分缓解各16例，无效8例，临床缓解率80.00%；对照组完全缓解8例，部分缓解13例，无效19例，临床缓解率52.50%。观察组临床缓解率明显高于对照组（P<0.05）。两组治疗8周及24周24 h尿蛋白定量、三酰甘油均较治疗前明显降低（P<0.05）；两组治疗8周及24周时白蛋白较治疗前明显升高（P<0.05）。观察组治疗24周后24 h尿蛋白定量、三酰甘油均显著低于对照组（P<0.05）；观察组治疗24周后白蛋白显著高于照组（P<0.05）。两组患者治疗4、8、24周后血糖、血清肌酐变化无统计学意义。两组不良反应比较，差异无统计学意义。结论 他克莫司联合激素治疗特发性膜性肾病的效果较好，可延缓肾功能恶化，安全性好。

Comparison on efficacy and safety of tacrolimus and leflunomide combined with hormone in treatment of idiopathic membranous nephropathy

Objective To evaluate and compare the efficacy and safety of tacrolimus and leflunomide combined with hormone therapy for idiopathic membranous nephropathy. Methods Patients with membranous nephropathy diagnosed by renal biopsy in Yulin Second Hospital (80 cases) were randomly divided into observation group (tacrolimus+hormone) and control group (LEF+hormone), 40 cases in each group. The levels of serum albumin, blood glucose, 24 h urine protein, serum cholesterol, serum triglyceride, and serum creatinine before and after treatment in the two groups were compared. Results There were 16 cases of complete remission and 16 cases of partial remission, 8 cases inefficient in observation group. The clinical remission rate of observation group was 80%. There were 8 cases of complete remission and 13 cases of partial remission, 19 cases inefficient in control group. The clinical remission rate of control group was 52.50%, which was significantly higher than that of control group (P<0.05). After treatment of 8 weeks and 24 weeks, the 24 h urinary protein and triglycerides were significantly lower than those before treatment, and the difference was statistically significant (P<0.05). Two weeks and 24 weeks after treatment, 24 h urinary protein and triglyceride in two groups were significantly lower than those before treatment (P<0.05) and the serum albumin was significantly higher than before treatment (P<0.05). After 24 weeks treatment, 24 h urinary protein and triglyceride in the observation group were significantly lower than that in the control group (P<0.05), and the albumin was significantly higher than that in the control group (P<0.05). There was no significant change in blood glucose and serum creatinine in two groups after 4, 8, and 24 weeks treatment. The adverse reactions of the two groups were compared, the difference was not statistically significant. Conclusion The effect of tacrolimus combined with hormone therapy on idiopathic membranous nephropathy is better, which can delay the deterioration of renal function and the safety is good.