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学科主题: 肾脏病学
题名:
他克莫司治疗IgA肾病的疗效及安全性的观察研究
其他题名: Efficacy and safety of tacrolimus in the treatment of IgA nephropathy
作者: 苏晓乐1; 师素芳1; 刘立军1; 陈育青1; 吕继成1; 张宏1
关键词: IgA肾病 ; 他克莫司 ; 蛋白尿 ; IgA nephropathy ; tacrolimus ; proteinuria
刊名: 临床药物治疗杂志
发表日期: 2015
DOI: 10.3969/j.issn.1672-3384.2015.01.005
期: 1, 页:18-24
收录类别: 中国科技核心期刊
文章类型: Journal Article
摘要: 目的:观察他克莫司治疗IgA肾病(IgA nephropathy, IgAN)的长期疗效和安全性。方法:回顾性分析我科IgAN随访队列中应用他克莫司治疗并且随访时间>1年的原发性IgAN患者,观察用药及随访期间患者尿蛋白定量、血清白蛋白水平及估算肾小球滤过率(eGFR)的变化,并评价用药相关不良事件。结果:共21例IgAN患者纳入本研究,平均年龄(29.4±10.6)岁,平均随访时间为(54.0±35.8)月,所有患者在应用他克莫司之前均应用了ACEI/ARB和/或激素免疫抑制治疗,且尿蛋白仍>1 g·d-1,应用他克莫司前的平均尿蛋白(4.84±2.40)g·d-1,平均eGFR(78.33±37.30) mL·min-1·1.73 m-2。5/21例eGFR(34.70±9.67)mL·min-1·1.73 m-2的患者在用药1~1.5月后因eGFR下降>15%而停药,其余16/21例患者用药时间≥6个月,其中13/16例(81.3%)在治疗平均(5.31±3.35)周时获得蛋白尿缓解,包括12例完全缓解和1例部分缓解,8/13例获得缓解的时间在应用他克莫司治疗后的4周内,患者用药前与治疗结束时的eGFR差异没有统计学意义(93.5±32.8)vs(80.4±32.5)mL·min-1·1.73m-2,P =0.27)。6/13例(46.2%)在他克莫司减量或停药后出现复发。用药相关不良事件包括感染(2例),新发高血压(1例),高尿酸血症(3例)等。结论:①他克莫司在对ACEI/ARB和/或激素免疫抑制治疗效果不佳的IgAN治疗中显现出快速的蛋白尿缓解趋势,但在CKD 3期以上的患者中应慎重使用。②他克莫司在减量或停药过程中复发率较高。 Objective:To investigate the clinical efifcacy and adverse reaction of tacrolimus in the treatment of IgA nephropathy.Methods:Biopsy-proven IgA nephropathy patients who had been treated with tacrolimus and with follow-up time more than 1-year in Renal Division Peking University First Hospital, were enrolled in this retrospective study. Urinary protein excretion, serum albumin levels, glomerular ifltration rate (eGFR), and tacrolimus related adverse events during the treatment and follow-up were evaluated.Results: A total of 21 patients with mean age (29.4 ± 10.6) years were analyzed. The mean follow-up time was (54.0 ± 35.8) months. All patients had been treated with ACEI/ARB and/or immunosuppressive therapy before tacrolimus therapy, and their urinary protein excretion were still more than 1g·d-1. Before tacrolimus therapy, the mean urinary protein excretion was (4.84±2.40) g·d-1 and mean eGFR was (78.33±37.30) mL·min-1·1.73m-2. 5/21 patients with mean eGFR (34.70±9.67) mL·min-1·1.73m-2 withdrew tacrolimus treatment within 1~1.5 months, because of more than 15% of eGFR decline. For 16 patients who were treated with tacrolimus more than 6 months, 13/16 cases (81.3%) achieved proteinuria remission, including 12 cases of complete remission and 1 case of partial remission. Mean times to achieve remission were (5.31±3.35) weeks. 8/13 cases achieved remission in 4 weeks. The level of eGFR before and after tacrolimus treatment withdrawal didn’t change signiifcantly in 16 cases (93.5±32.8) vs (80.4±32.5) mL·min-1·1.73m-2,P = 0.27). In patients who achieved complete or partial remission, 46.2% experienced relapse during follow-up. Other adverse events included infection (2 cases), new-onset hypertension (1 case) and hyperuricemia (3 cases).Conclusion:①Tacrolimus showed a rapid proteinuria remission in IgAN patients with ACEI/ARB and/or hormone immunosuppressive therapy resistance, but it should be used cautiously in patients with CKD stage 3.②There was a high relapse rate during tapering or cessation of tacrolimus therapy.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/45970
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.北京大学第一医院肾内科,北京大学肾脏病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室 北京大学,北京 100034
2.山西医科大学第二医院肾内科,山西省肾脏病研究所,太原 030001
3.北京大学第一医院肾内科,北京大学肾脏病研究所,卫生部肾脏疾病重点实验室,慢性肾脏病防治教育部重点实验室 北京大学,北京 100034

Recommended Citation:
苏晓乐,师素芳,刘立军,等. 他克莫司治疗IgA肾病的疗效及安全性的观察研究[J]. 临床药物治疗杂志,2015(1):18-24.
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