Clinical Study Of Tacrolimus And Cyclosporine Combined With Semiquantitative Glucocorticoid In The Treatment Of Idiopathic Membranous Nephropathy

BackgroundIdiopathic membranous nephropathy is a kind of kidney disease,which affects the quality of life of patients.Corticosteroids can treat idiopathic membranous nephropathy,but treatment alone is poor,so it is necessary to combine immunosuppressive agents.Tacrolimus is a potent immunosuppressive agent,immunosuppressive effect is strong,can be biliary and fecal metabolism,side effects are relatively small.PurposeTo evaluate the clinical efficacy and safety of tacrolimus and cyclosporine in the treatment of idiopathic membranous nephropathy in patients with stage Ⅰ-Ⅲ.Method:72 patients admitted to our hospital with clear pathological diagnosis of stage Ⅰ-Ⅲ patients with idiopathic membranous nephropathy,which were randomly divided into experimental group(tacrolimus combined with half dose of corticosteroid therapy)and control group(cyclosporine combined with half dose of corticosteroids),respectively 32 cases and 40 cases in two groups.The treatment for six months,the blood pressure of patients during treatment,24 h urinary protein,blood creatinine and other indicators of regular inspection and measurement of mean arterial pressure,at the same time,the mean arterial pressure in patients,adverse reactions,and cyclosporine,tacrolimus blood concentration measurement,data processing using SPSS17.0 software,using the paired t test to compare the measurement data,the results were expressed by percentage of hundreds of cases.If P<0.05 showed that the results were significantly different,P<0.01 showed significant differences.Result1 Compare the basic information of the two groups: gender,age,body weight index,hypertension,diabetes,total cholesterol concentration and other factors,there is no statistical difference between the two groups can be compared2 After 12,24 weeks treatment,compared with the control group,the experimental group 24 hours urine protein,glycerol three cool levels were significantly reduced,there were statistically significant differences(P<0.05);serum albumin was increased,the results were statistically significant(P<0.05).Serum creatinine,blood glucose data were compared,the difference was not statistically significant(p>0.05).3 After 24 weeks treatment,there were 18 cases in the experimental group,14 cases were partial remission,8 cases were ineffective,the effective rate was 80%;the control group was 5 cases,partial remission was 12 cases,15 cases ineffective,the effective rate of treatment was 53.1%.There was significant statistical difference(P<0.01)between the two groups in the treatment remission rate.4 The experimental group for 1 cases of allergic diarrhea,no liver and kidney damage and other adverse reactions,including 1 cases of fever.In the control group there were 3 cases of dyspepsia,infection and skin rash were 2 cases and 1 cases,3 cases had lower white blood cell content.5 Experimental group of 40 patients in the blood drug concentration in the ng/m L 4.88~11.34 range.According to the concentration test results,increase or decrease the dosage of tacrolimus,patients in the treatment of blood concentrations of the drug in each phase of the average value is maintained between 5.76-6.35ug/L,stable fluctuations.The blood drug concentration of 32 patients in the cyclosporine group fluctuated between 100~200ng/ml,according to the concentration detection results,increase or decrease the dose of cyclosporine,patients in the treatment of blood concentration in each phase of the average value of the 121-132ug/L,stable fluctuations.Conclusion1 Tacrolimus combined with half dose of corticosteroids and cyclosporine combined with half dose of corticosteroids can effectively reduce the amount of urinary protein in 24 hours.But the combination of tacrolimus combined with half dose of corticosteroids in the treatment group compared with the combination of cyclosporine a half dose of corticosteroid treatment group,the shorter the time,the better curative effect.2 Half the amount of tacrolimus combined with corticosteroid group and cyclosporine combined with half dose of corticosteroids in the treatment group,serum creatinine,blood glucose,liver function and other indicators showed a steady fluctuation in the group stage and each treatment group compared to the same period,the difference was not statistically significant.