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目的探究他克莫司治疗难治性IgA肾病的有效性和安全性。方法纳入2008年6月至2013年9月第二军医大学长征医院收治、经病理确诊的IgA肾病患者共9例,均经肾素-血管紧张素系统(RAS)阻断剂和激素治疗无效后给予他克莫司治疗。观察患者用药后的缓解情况(完全缓解和部分缓解)及达到缓解所需时间、复发次数、他克莫司给药剂量和药物不良反应。结果他克莫司的起始给药剂量为(1.89±0.33)mg/d。经6个月的他克莫司治疗后,6例患者获得完全缓解、2例部分缓解、1例治疗抵抗,大多数患者在治疗后的前2个月内获得缓解。患者的24h尿蛋白定量下降[(3.05±1.35)g vs(0.85±1.54)g,P<0.05],血清白蛋白水平升高[(27.00±8.37)g/L vs(37.33±8.08)g/L,P<0.05]。1例患者给予他克莫司治疗后表现为高血压加重,其他患者未见不良反应。8例蛋白尿缓解的患者中,3例出现复发,在调整激素剂量和他克莫司剂量后均得到缓解。结论他克莫司可使难治性IgA肾病患者的蛋白尿症状缓解,且不良反应少。
Objective To investigate the efficacy and safety of tacrolimus in refractory IgA nephropathy. Methods Nine patients with pathologically confirmed IgA nephropathy were enrolled in the Changzheng Hospital of the Second Military Medical University from June 2008 to September 2013. All patients were treated with renin-angiotensin system (RAS) blocker and hormone therapy was ineffective Give tacrolimus treatment. Patients were observed after treatment of remission (complete remission and partial remission) and to achieve the required time to remission, the number of relapsing, tacrolimus dose and adverse drug reactions. Results The initial dose of tacrolimus was (1.89 ± 0.33) mg / d. After 6 months of tacrolimus treatment, 6 patients achieved complete remission, 2 were partially relieved, 1 was treated resistant and most of the patients were relieved in the first 2 months after treatment. The level of serum albumin was significantly lower in patients with urinary protein ([(3.05 ± 1.35) g vs (0.85 ± 1.54) g, P <0.05] L, P <0.05]. One patient showed worsening of hypertension after receiving tacrolimus, and the other patients showed no adverse reaction. Of the 8 patients with proteinuria, 3 developed relapse and were relieved after adjusting for hormonal dose and tacrolimus dose. Conclusion Tacrolimus can relieve proteinuria in patients with refractory IgA nephropathy with less adverse reactions.