| Membranous nephropathy is one of the major pathological types of nephrotic syndrome,which is divided into idiopathic membranous nephropathy and secondary membranous nephropathy.The two types have different treatment plans.The latter treatment is aimed at the cause of disease,while the former has more treatment programs,including calcineurin inhibitors combined with hormone therapy?alkylating agent combined with hormone therapy ? leflunomide combined with hormone therapy ?Mycophenolate Mofetil?tripterygium glycosides combined with hormone therapy,rituximab,eclomycin monoclonal antibody,intravenous injection of high-dose immunoglobulin,adrenocorticotropic hormon?imidazole thiopurine and traditional chinese medicine combined with modern medicine.In the calcineurin inhibitors combined with hormone therapy regimen,the represent medicine are tacrolimus and cyclosporine A.Inhibition of cellular immunity and humoral immunity Tacrolimus is Cs A 10 to 100 times than Cs A,and hepatotoxicity is smaller.Tacrolimus is a novel immunosuppressive agent of macrolide,and its mechanism of action is to inhibit calcium phosphatase by complexing with the FK506 binding protein in the cytoplasm to organize a series of lymphocytes transcription,and specifically inhibit T cell activation and B lymphocyte proliferation.Tacrolimus combined with prednisone treatment process is longer and use more medication in IMN.This topic intends to track a case of typical cases,the efficacy of its program and safety analysis.Treatment of MN clinically common tacrolimus and prednisone program,and combined with irbesartan and Bailing capsules.Corbrin capsule can be used to improve clinical symptoms and urinary protein levels,enhance clinical efficacy.Corbrin Capsule is one of the combination of tacrolimus.Corbrin is a kind of capsule made of dried powder of Cordyceps sinensis obtained by deep fermentation of mycelia.Cordyceps is rich in ingredients and the main components play a regulatory role in the kidney and immune system.Tacrolimus is mainly transported through P-glycoprotein of intestinal mucosal epithelial cells,the vast majority of liver enzyme CYP3A4 metabolism,some of which drugs by inhibiting P-glycoprotein or CYP3A4 and affect the plasma concentration of tacrolimus.The literature did not find the interaction between tacrolimus and Corbrin capsules.In this study,we will study the effect of Corbrin Capsule on the pharmacokinetics of tacrolimus in Beagle dogs body,with a view to providing reference for clinical rational drug use.Part one Influence of corbrin on the pharmacokinetics of tacrolimusObjection: To explore the pharmacokinetics of tacrolimus for Corbrin in the Beagle dog.Methods: Effect of Corbrin on the pharmacokinetics of tacrolimus in the Beagle dog.Self-contrast method was conducted.Control group:(n=6)Oral tacrolimus capsules before(0h)and after 1mg,Blood samples were collected from small saphenous vein of the beagles at 0,0.167,0.333,0.5,0.667,0.833,1,1.5,2,3,4,6,8,12,and 24 h,In EDTA-K2 anticoagulant tube.The plasma concentration of tacrolimus was monitored by chemiluminescence microparticle immunoassay.The cleaning period is one week.Test group: oral tacrolimus combined with Corbrin capsule,blood collection time,determination method equivalent.The main pharmacokinetic parameters were calculated using DAS(version 2.1.1)software.Using SPSS 21.0 statistical software for the data paired t test.Result: There were no significant differences in the plasma concentration,the area under the curve,the elimination of half-life,peak time,apparent distribution volume and clearance rate between the two groups after taking a single dose of tacrolimus capsules and 1 mg of tacrolimus capsules combined with 2 grain of Corbin capsules except peak concentration.Conciusion: There were no significant differences in the plasma concentration,the area under the curve,the elimination of half-life,peak time,apparent distribution volume and clearance rate between the two groups after taking a single dose of tacrolimus capsules and 1 mg of tacrolimus capsules combined with 2 grain of Corbin capsules except peak concentration.However,Corbrin Capsule and tacrolimus combined with the human pharmacokinetics to be further studied.Part two Analysis of medcationt to treat a typical case of IMNObjection: The treatment plan and safety of typical cases of IMN were analyzed in order to provide reference for clinical rational drug use.Methods: Analysis of typical cases of idiopathic MN.To track a typical idiopathic membranous nephropathy patients,combined with clinical symptoms of patients,including urinary protein,biochemical indicators,blood,tacrolimus plasma concentration and other adverse drug reactions and so on.And to analyze the curative effect and safety of the treatment regimen and the combination therapy,so as to provide reference for clinical rational drug use.Result: 1 The pathological results of the patient was membranous nephropathy ?,and tacrolimus combined with prednisone was identified as a treatment regimen.15 days later 24 hours the amount of urine protein from the original 6.58g/d down to 5.57g/d.The plasma concentration of tacrolimus was increased from 3.2 ng / m L to 11.7 ng / m L before administration of Wu zhi capsules and the amount of urinary protein at 24 hours was increased after 15 daysof(2,3/d)From 5.57 g/d to 1.22 g/d and plasma albumin values increased from 30.21g/L to 33.40 g/L.When the Wu zhi capsules were reduced to(2,2/d),tacrolimus the plasma concentration was reduced to 10.9 ng / ml,24 h urinary protein was reduced to 1.17g/d and albumin increased to 41.10g/L.(0.5mg,2/d),the blood steady-state trough concentration reached 8.0 ng/ml,the urinary protein was reduced to 0.47g/d at 24 hours,Albumin increased to 45.10 g/l.Patients with 24-hour urine protein,biochemical indicators reached the normal range and stable for some time,disable tacrolimus and hormones,single service irbesartan.(0.5mg,2/d)irbesartan(0.3g,2/d)24 hours urine protein is not elevated after 24 hours of abnormal urinary protein index.2 Integrated traditional Chinese and Western medicine treatment of tacrolimus(0.5g,2/d),irbesartan(0.15 g,2/d)traditional Chinese medicine includes Angelica,Loranthaceae,Centella,Poria,Rhizoma Chuanxiong,Ganoderma lucidum,fried silkworm,astragalus,licorice,angelica,Radix dipsaci,Cibotium barometz,Radix Rehmanniae Preparata,Fructus Corni.After Apply this program,the patient with lumbar debility,easy fatigue,hot flashes and body deficiency symptoms was improved,mental status improved,24 hours urine protein from the previous 1.10g/d down to 0.17g/d.3 Patients before oral administration of tacrolimus nausea,usually common dizziness.Adjust for taking after meals.The side effects of hormones mainly manifested as osteoporosis,plus ossification of triol soft capsules,and injection of ibandronic acid but its easily lead to muscle soreness.Dipyridamole adverse reactions often dizziness,to aspirin.Captopril causes irritating cough,replaced by irbesartan.Conciusion: 1 Tacrolimus combined with prednisone treatment of the program produced a certain therapeutic effect,the patient taking Wu zhi capsules can increase the plasma concentration of tacrolimus.It is recommended that patients adjust the dose of tacrolimus and pentaester capsules according to the 24-hour urinary protein outcome and biochemical markers.To achieve the purpose of treatment under the premise of reducing drug varieties,reduce drug dose.2 Combination of traditional Chinese and Western medicine treatment of the patient's body played a very good conditioning effect,and reduce the urine protein.Such as poor mental state of patients,physical discomfort,the role of Western medicine is not obvious to consider the combination of traditional Chinese and Western medicine treatment.3 MN generally requires long-term treatment.Combined with typical cases of adverse drug reactions during treatment,rest time,diet,etc.give some suggestions.Oral tacrolimus produce nausea,retching,usually common dizziness.Recommended to take tacrolimus after meals,to monitor tacrolimus plasma concentration take medication before 20 minutes.When the dizziness is to remind patients usually driving need to pay attention.The adverse reactions of hormones mainly osteoporosis,can take calcitriol,vitamin D calcium chewable tablets,and injection of ibandronate,the adverse reactions are muscle soreness,but will disappear after a few days.For the prevention of thromboembolism can take aspirin,The adverse effects of dipyridamole should be dizziness.For the prevention of thromboembolism can take aspirin,The adverse effects of dipyridamole should be dizziness.In addition to taking cortopril after cough patients,adjustable drugs for irbesartan.Recommend other patients' daily routines,maintain a positive attitude,Bland diet,eat low-fat protein. |
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