Analysis Of Comparing The Effects Of Cyclophosphamide And Tacrolimus In The Treatment Of Idiopathic Membranous Nephropathy

Objective:According to existing research,idiopathic membranous nephropathy is considered to be an autoimmune nephropathy.The 2020 KDIGO clinical practice guidelines recommend immunosuppressive therapy for IMN patients who are at risk of progression.This study analyzed the effects of cyclophosphamide and tacrolimus in the treatment of IMN,and looked for factors that affect the treatment effect of IMN.Try to provide a basis for the best clinical treatment programs.Methods:In this study,we selected 176 patients who were diagnosed as IMN at the First and Second Nephrology Department of Shengjing Hospital Affiliated to China Medical University from June 2015 to February 2020.Clinical data were collected before receiving immunosuppressant therapy（as the baseline）,3,6,and 12 months after treatment.Analyze whether there is any difference in clinical data and remission of IMN patients after different treatments,and a logistic regression model was established to explore influencing factors of the treatment effect of IMN patients.Results:Before treatment,there was no significant difference in clinical data between the two groups of IMN patients with hormone combined with cyclophosphamide and hormone combined with tacrolimus（P>0.05）.There are significant differences in Alb,TP,HDL-C,and uric acid levels between the two treatment groups in the third month after treatment（P<0.05）.The Alb levels of patients in the two treatment groups at the 6th month of treatment were statistically different from the Alb levels at the 3rd month after treatment and the baseline（P<0.05）.After 12 months of treatment,there were significant differences in Alb and TP levels between the two groups of patients compared with baseline（P<0.05）.The levels of Alb,TP,and uric acid in the tacrolimus group were higher than those in the cyclophosphamide group at the 6th and 12th months after treatment,and the difference was statistically significant（P<0.05）.There was no statistical difference in the remission rate of the three observation points after treatment between the two treatment groups.Binary logistic regression showed that the baseline Alb,anti-PLA₂R antibody,D-dimer levels had a statistically significant effect on the remission of IMN patients at 12month of treatment（P<0.05）.Conclusion:Both hormone combined with cyclophosphamide and hormone combined with tacrolimus have high remission rates for IMN in 12 months treatment.The improvement of hypoalbuminemia in IMN patients with hormone combined with tacrolimus treatment is more obvious,but hyperuricemia is also obvious,attention and intervention should be paid timely.Serum Alb,anti-PLA₂R antibody,D-dimer levels before medication can predict the treatment outcome of IMN.