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| 他克莫司治疗难治性IgA肾病的有效性和安全性 |
| 卞蓉蓉1,伍力学2,徐德超1,高翔1,徐成钢3* |
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(1. 第二军医大学长征医院肾内科, 解放军肾脏病研究所, 上海 200003;
2. 第二军医大学长征医院急救科, 上海 200003;
3. 第二军医大学东方肝胆外科医院肾内科, 上海 200438
*通信作者) |
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| 摘要: |
| 目的 探究他克莫司治疗难治性IgA肾病的有效性和安全性。方法 纳入2008年6月至2013年9月第二军医大学长征医院收治、经病理确诊的IgA肾病患者共9例，均经肾素-血管紧张素系统（RAS）阻断剂和激素治疗无效后给予他克莫司治疗。观察患者用药后的缓解情况（完全缓解和部分缓解）及达到缓解所需时间、复发次数、他克莫司给药剂量和药物不良反应。结果 他克莫司的起始给药剂量为（1.89±0.33） mg/d。经6个月的他克莫司治疗后，6例患者获得完全缓解、2例部分缓解、1例治疗抵抗，大多数患者在治疗后的前2个月内获得缓解。患者的24 h尿蛋白定量下降[（3.05±1.35） g vs （0.85±1.54） g，P<0.05]，血清白蛋白水平升高[（27.00±8.37） g/L vs （37.33±8.08） g/L，P<0.05]。1例患者给予他克莫司治疗后表现为高血压加重，其他患者未见不良反应。8例蛋白尿缓解的患者中，3例出现复发，在调整激素剂量和他克莫司剂量后均得到缓解。结论 他克莫司可使难治性IgA肾病患者的蛋白尿症状缓解，且不良反应少。 |
| 关键词: IgA肾病 他克莫司 蛋白尿 药物剂量计算 不良反应 |
| DOI：10.16781/j.0258-879x.2017.06.0794 |
| 投稿时间：2016-10-24修订日期：2016-12-20 |
| 基金项目: |
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| Efficacy and safety of tacrolimus for patients with refractory IgA nephropathy |
| BIAN Rong-rong1,WU Li-xue2,XU De-chao1,GAO Xiang1,XU Cheng-gang3* |
(1. Department of Nephrology, Kidney Disease Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Emergency, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
3. Department of Nephrology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the efficacy and safety of tacrolimus (TAC) therapy in patients with refractory IgA nephropathy. Methods Nine IgA nephropathy patients were included in this study were treated from Jun. 2008 to Sep. 2013 in Changzheng Hospital of Second Military Medical University. All patients received TAC therapy after the renin-angiotensin system (RAS) blockade therapy and steroid therapy failed. The main outcome was complete or partial remission. Secondary outcomes included the time required to remission, the frequency of recurrence, TAC dosage and adverse events. Results The initial dosage of TAC was (1.89±0.33) mg/d. After treatment with TAC for 6 months, 6 patients achieved complete remission, 2 partial remission and 1 treatment resistance, and most of the remission patients achieved remission during the first 2 months of TAC therapy. The urine protein level of enrolled patients was significantly decreased ([3.05±1.35] g/24 h vs [0.85±1.54] g/24 h, P<0.05) and the serum album level of all patients was significantly improved ([27.00±8.37] g/L vs [37.33±8.08] g/L, P<0.05). One patient receiving TAC therapy presented worsened hypertension, and no other adverse event was observed in this study. Three of 8 proteinuria remission patients had relapses and achieved remission by adjusting the dosages of steroids and tacrolimus. Conclusion TAC can improve proteinuria in patients with refractory IgA nephropathy, with less adverse reactions. |
| Key words: IgA nephropathy tacrolimus proteinuria drug dosage calculations adverse reactions |
