| The research objective was to compare the efficacy and safety of tamoxirolimus combined with prednisone and cyclophosphamide combined with prednisone in the treatment of idiopathic membranous nephropathy,so as to search the best treatment for idiopathic membranous nephropathy.In this study,a total of 80 patients diagnosed with IMN by renal biopsy were enrolled,including 51 patients treated with tacrolimus combined with prednisone and29 patients treated with cyclophosphamide combined with prednisone.Patients receiving tacrolimus combined hormone therapy received oral tacrolimus at 0.1mg/kg·d in two 12-hour intervals of the same dose.During the 1-year treatment period,the blood concentration of tacrolimus was adjusted and maintained at 5-10ng/m L according to the relevant laboratory results.Patients receiving cyclophosphamide injection were given 750mg/ m2 of cyclophosphamide body surface,receiving treatment once a month at the beginning and once every 2-3 months at the end.The cumulative dose should not exceed 10 g.In the tacrolimus + hormone group and the cyclophosphamide + hormone group,the oral prednisone dose was 1 mg/kg/d,gradually decreasing by 5 mg every 2 weeks.When it was reduced to 20 mg/d,the dose should be reduced slowly,decreasing by 5 mg every 4 weeks until it was reduced to 10mg/d.A total of 40(78.43%)patients in the tacrolimus group and 20(75.86%)patients in the CYC group achieved remission(partial or complete)over the course of 12 months of treatment.The remission rate and complete remission rate of the survival curve of the two groups were similar(p >0.05).After treatment,urinary protein was significantly reduced and serum albumin was significantly increased in both groups,with statistical significance before and after treatment(P=0.00).There was no significant statistical difference in remission rate between the two groups(P=0.791).In terms of adverse reactions,the infection rate of tacroximus combined hormone group(19.6%)(10 patients)was lower than that of cyclophosphamide combined hormone group(48.2%)(14 patients),and there was a statistical difference in the infection rate between the two groups(P=0.007).In terms of blood glucose,the tacrolimus combined hormone group(29.4%)(15 subjects)was higher than the cyclophosphamide combined hormone group(13.8%)(4 subjects)(p =0.115).In terms of renal impairment,tacrolimus combined hormone group of 7 people(13.7%),cyclophosphamide combined hormone group 3 people(10.3%)appeared higher creatinine,creatinine increased in patients with two groups of no statistical difference(P = 0.660),and does not appear during treatment for elevated creatinine discontinuation or caused by a tacrolimus end-stage renal disease(ESRD).In terms of increased uric acid,11 patients in the tacrolimus combined hormone group(21.6%)and 4 patients in the cyclophosphamide combined hormone group(13.8%)presented increased uric acid in this study.There was no statistical difference in the elevation of uric acid between the two groups(P=0.392),and no patients presented gout symptoms such as joint pain.In terms of liver function damage,6 patients(11.8%)in tacrolimus combined hormone group and 4 patients(13.8%)in cyclophosphamide combined hormone group had liver function damage,and there was no statistical difference(P=0.792)in liver damage between the two groups(P=0.792),and those who did not have liver failure during treatment or stopped taking medicine due to abnormal liver function.In terms of remission rate,there was no statistical difference between tacrolimus combined with prednisone and cyclophosphamide combined with prednisone in the treatment of idiopathic membranous nephropathy.In terms of adverse reactions,the incidence of tacrolimus combined with hormone therapy was lower than that of cyclophosphamide combined with hormone therapy.Although there was no statistical difference between the two groups in terms of other adverse reactions,the tacrolimus combined hormone group had better safety from the data analysis alone. |
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