| Background and ObjectivesIdiopathic membranous nephropathy(IMN)is an adult primary nephrotic syndrome is one of the most common pathological type of syndrome in recent 10 years,the incidence of [1] was significantly increased,and improve the popularity of causes of increased MN and the aging of the population,renal biopsy,renal biopsy indications further wide,environment pollution and so on.Guidelines for the improvement of the global kidney disease outcomes(KDIGO)guidelines suggest that corticosteroids should not be used alone in the treatment of IMN.The traditional treatment with hormone combined with cyclophosphamide,but the side effects of cyclophosphamide is more obvious,especially for the gonad damage is bigger,have a greater impact on fertility requirements of patients.Even if there is no fertility requirements,but with gonadal damage,changes in the level of sex hormones on the patient’s sexual function,personality,bone metabolism and other quality of life will also have some adverse effects.Tacrolimus is a new generation of calcineurin inhibitors in recent years,much progress has been achieved in the field of application of the treatment of renal diseases,has been widely used in MCNS,membranous nephropathy and focal segmental glomerulosclerosis and other pathological types,and the use of glucocorticoid in low dose,less adverse reaction,as one of the main options of membranous nephropathy.At present,there are no reports on the effects of different schemes on the level of sex hormones in adults.From March 2015 to October 2015,we are in nephrotic syndrome patients with IMN showed respectively application of tacrolimus and cyclophosphamide,observe the effect on sex hormone level of patients,to provide reference for the choice of treatment IMN.To investigate the efficacy of tacrolimus combined with glucocorticoid on idiopathic membranous nephropathy(IMN)effect and significance of sex hormone levels in patients with nephrotic syndrome.MethodsFrom March 2015 to October 2015,46 cases of IMN patients with nephrotic syndrome were divided into tacrolimus group(n = 28)and control group(n = 18).The tacrolimus group to give Tacrolimus Capsules 0.05 ~ 0.1 mg/(kg·d),2 times a day on an empty stomach;Prednisone Acetate Tablets starting dose of 0.5 mg/(kg·d),morning orally,1 times /d,8 weeks after reduction.The control group was treated with cyclophosphamide 0.8 g intravenous drip,1 times every 2 weeks,while giving Prednisone 1 mg/(kg-D)morning orally,1 times /d,8 weeks after reduction.The two groups were treated for 3 months.Before treatment,treatment for 1 months,3 months of treatment,24 h urinary protein quantitative detection of two groups of patients,serum albumin level,before treatment and 3 months of treatment,two groups of sex hormone testosterone(T),estradiol(E2),follicle stimulating hormone,luteinizing hormone(FSH)hormone(LH),prolactin(PRL),sex hormone binding globulin(SBG)levels.ResultsCompared with before treatment,the treatment of tacrolimus group 1 months,24 hours urinary protein quantitative level reduced,serum albumin level increased(P < 0.05),cyclophosphamide treatment group 1 months,24 hours urinary protein quantitative level was reduced(P < 0.05);the two group for 3 months,24 hours urinary protein quantitative level decreased,serum albumin levels were significantly higher(P<0.05).Compared with cyclophosphamide group,the tacrolimus group 1,3 months,24 hours urinary protein quantitative level,serum albumin level increased(P < 0.05).Compared with before treatment,treatment for 3 months,the two groups decreased level of serum E2,T and SBG,FSH and LH levels were elevated(P < 0.05).Treatment for 3 months,the tacrolimus group of serum E2,T and level of SBG are higher than the control group,FSH is lower than the control group(P < 0.05).Tacrolimus group the incidence of adverse reaction is lower than the control group(P < 0.05).ConclusionsCompared with cyclophosphamide scheme,the clinical manifestation of IMN patients of nephrotic syndrome with tacrolimus scheme work faster and better,and less inhibitory effect on the sex hormones. |
PDF Full Text Request