| Objective:Membranous nephropathy is an autoimmune disease of the glomerulus with an increasing incidence and widely varying prognosis,with approximately30% of patients progressing to end-stage renal disease.Among them,idiopathic membranous nephropathy accounts for about 80%.There are many treatment options for IMN,but various families have different views on IMN treatment due to efficacy,adverse effects and cost.Cyclosporine A has been shown to be effective for IMN,but current guidelines have broad recommendations for empirical Cs A therapeutic concentrations,and the exact relationship between its blood concentration and drug efficacy and side effects is still uncertain,which brings difficulties to the formulation of clinical treatment plans.Our study mainly explored the efficacy and safety of different concentrations of Cs A in the treatment of IMN patients.Methods:In this retrospective study,107 IMN patients diagnosed by kidney biopsy and initially treated in the Affiliated Hospital of Chengde Medical College from June 2019 to June 2022 were selected.The Cs A serum trough concentration of patients was determined by high performance liquid chromatography,the optimal Cs A trough concentration of each patient in remission was recorded,and clinical data of patients were collected.The mean value of Cs A serum trough concentration was divided into low Cs A serum trough concentration group and high Cs A serum trough concentration group.The remission of IMN patients in the two groups after 6 months of treatment and the changes of clinical indicators were compared,as well as the complete remission rate,remission time and adverse reactions of patients at the end of follow-up.Results:1.A total of 107 patients with IMN were enrolled,including 72 males(67.3%)and 35 females(32.7%),with an average age of 52.48 ± 12.85 years.T he average blood trough concentration of Cs A in the included patients was 81.81(50.27-139)ng/m L,and the patients were divided into two groups based on the average blood trough concentration of Cs A in all patients.There were 56 patients in the low Cs A concentration group,the average blood concentration was 64.74 ± 8.66 ng/m L.There were 51 cases in the high Cs A concentration group,and the average blood concentration was 100.54 ± 13.9ng/m L.There was no statistical difference in the basic clinical data between the two groups(P>0.05).2.After 6 months of treatment,12 cases(21.4%)in the low Cs A concentr ation group had complete remission,and 20 cases(39.2%)in the high Cs A con centration group had complete remission,with a statistically significant differe nce(P<0.05).The median change of 24-hour urine protein in the low Cs A co ncentration group was-5.41g/L(-7.15 to-3.28),and the median change in the high Cs A concentration group was-7.00g/L(-10.51 to-4.53).There was a stat istical difference between the two groups(P<0.05).The high and middle num bers of serum albumin in the two groups were 9.71ng/ml(4.97 to 13.73)and 13.75ng/m L(10.3 to 16.31)respectively,and the difference was statistically sig nificant(P<0.05).There was no statistically significant change in serum creati nine in the two groups(P>0.05),and no patients with end-stage renal disease developed.3.At the end of follow-up,there were no significant differences in total r esponse rate,complete response rate,partial response rate and partial response time between the two groups(P>0.05).The difference in complete response t ime was statistically significant(P<0.05).Survival analysis showed that the c omplete response time and total response time in the high Cs A concentration g roup were shorter than those in the low Cs A concentration group,and the diffe rence was statistically significant(P<0.05).4.Gastrointestinal reactions,persistent nephrotoxicity,infection,and ging ival hyperplasia were higher in the high Cs A concentration group than in the l ow Cs A concentration group,but the differences were not statistically signific ant(P>0.05).Acute reversible nephrotoxicity was significantly higher in the h igh Cs A concentration group than in the low Cs A concentration group,and the difference was statistically significant(P<0.05).Conclusion:The remission rate of IMN patients treated with low concentration Cs A is comparable to that of high concentration Cs A,and the risk of nephrotoxicity is lower. |
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