Effect Of Different Methods On Idiopathic Membranous Nephropathy After Treatment

Objective In the clinical treatment of idiopathic membranous nephropathy?IMN?,usually immunosuppressive agents will be used,but to choose what method is still controversial.In this study,the clinical efficacy of three methods are analyzed by retrospective observation:hormone combined with cyclosporine?CSA?,hormone combined with tacrolimus?TAC?,hormone combined with cyclophosphamide?CTX?.Methods Collected 53 Cases of patients diagnosed as IMN by renal biopsy in Second Affiliated Hospital of Fujian Medical College from January 2014 to July 2016.IMN of the sample was in pathological type I^III,immunofluorescence is positive PLA2R,IgG classification was mainly IgG4 and C1q was negative.Those patients regularly visited clinic in Second Affiliated Hospital of Fujian Medical College after discharged from hospital,with complete follow-up data and pathological data.Patients were divided into group CSA TAC and CTX representing different methods,for a 48-week treatment.The change of remission rate,24h urinary protein,serum albumin,serum creatinine and other adverse reactions in 12^th,24^th,48^th week were monitored and compared.Results In 12^th week of treatment,the effective rate of 15 patients in group CSA was13%,while effective rate of 18 cases in group TAC was 50%and that of 20 cases in group CTX was 20%respectively.In 24^th week,the effective rate of 15 patients in group CSA was 33%,that of 18 cases in group TAC was 72%and effective rate of 20cases in group CTX was 60%.In 48^th week,the effective rate of 15 patients in group CSA was 73%,effective rate of 18 cases in group TAC was 83%and that of 20 cases in group CTX was 80%respectively.After a period of treatment in this study,all samples were decreased in 24h urinary protein?P<0.05?,while serum albumin of group TAC and CTX had noticeable increase in 12^th week treatment?P<0.05?.After48-week treatment,serum albumin of three groups were increased significantly?P<0.05?,and serum creatinine of three groups had no noticeable changes?P<0.05?.In the study,when the treatment was given for 12 weeks,tacrolimus had a higher rate of remission than that of cyclosporine?P<0.05?.In 24^th week,tacrolimus had a higher rate of remission than that cyclosporine?P<0.05?.In 48^th week,there was no significant difference in the rate of direct remission?P>0.05?between tacrolimus,cyclosporine and cyclophosphamide in three treatments.During the study,in CSA group 2 patients had lower respiratory tract infections and 1 had a recurrence after remission during the treatment period.In CTX group,there was 1 case of lower respiratory tract infection,1 case had pulmonary embolism during the treatment.In TAC group,1 case had lower respiratory tract infection,and 1 case had interrupted treatment during the treatment with the obvious increase of serum creatinine.Conclusions According to the results of 3 methods CSA,TAC and CTX,firstly hormone combined with tacrolimus?TAC?was better for short-term?12 weeks?treatment,secondly TAC,CSA and CTX all had good clinical effects in the mid-term?48 weeks?,and had less complications.