霉酚酸酯联合他克莫司治疗激素抵抗型难治性肾病综合征的疗效观察

【目的】探讨霉酚酸酯（MMF）联合他克莫司（TAC）治疗激素抵抗型肾病综合征（SRNS）的疗效、不良反应。【方法】收集SRNS患者74例，其中微小病变（MCD）32例、局灶节段性肾小球硬化（FSGS）22例、弥漫性系膜增生（DMP）20例，所有患者采用 MMF 1 g/d和糖皮质激素50 mg（隔日一次）治疗（第一步治疗）；第一步治疗仍未实现临床缓解的患者，则自动进入第二步治疗方案，即停用激素，采用MMF 1 g/d联合T AC 3 mg/d治疗6个月，观察不同治疗方案和病理类型的疗效及不良反应。【结果】74例SRNS患者接受第一步治疗，24例（32．4％）患者达到完全缓解，4例（5．4％）部分缓解；余下46例未出现临床缓解的患者停用激素，接受第二步治疗，22例（47．8％）患者达到完全缓解，4例（8．7％）患者达到部分缓解。不同病理类型缓解率比较有显著性差异（ P＜0．05），其中MCD缓解率最高，FSGS缓解率最低。治疗过程中所有患者均无明显不良反应。【结论】MMF联合TAC治疗SRNS ，疗效满意，值得临床推广应用。

Observation on the Efficacy of Mycophenolate Mofetil Combined with Tacrolimus for the Treat-ment of Steroid-resistant Refractory Nephrotic Syndrome

Objective]To explore the efficacy and adverse reaction of mycophenolate mofetil （MMF） com-bined with tacrolimus（TAC） for the treatment of steroid-resistant nephrotic syndrome（SRNS） .Methods]To-tally 74 SRNS patients were collected .Pathological types included 32 cases of minimal lesion（MCD） ,22 cases of local segmental glomerulosclerosis （FSGS ） and 20 cases of diffuse mesangial proliferation （DM P ） .All pa-tients were treated with MMF 1g/day and prednisolone 50mg（alternate day） for 6 months（first-step treat-ment） .For the patients without clinical remission after the first-step treatment automatically received the sec-ond-step treatment i .e .the withdrawal of steroids and then MMF 1g/day combined with TAC 3mg/day for 6 months .The efficacy of different therapy methods ,pathological types and adverse reaction were observed .Results]In 74 SRNS patients receiving the first-step treatment ,24 patients（32 .4% ） got complete remission , and 4 patients（5 .4% ） got partial remission ,and the other 46 patients did not get clinical remission and then stopped steroids and received the second treatment .Among these 46 patients ,22 patients（47 .8% ） got com-plete remission and 4 patients（8 .7% ） got partial remission .There was significant difference in the remission rate among different pathological types （ P 〈0 .05） .The remission rate of MCD was the highest and that of FSGS was the lowest .No obvious adverse reaction was found in all patients during the therapy .Conclusion]MMF combined with TAC for the treatment of SRNS has satisfactory effect ,so it is worthy of clinical promo-tion .