| Objective:To compare the different clinical results of different treatment schemes for idiopathic membranous nephropathy and explore the best treatment scheme.Methods:From July 2015 to July 2017,183 patients with idiopathic membranous nephropathy were enrolled after renal biopsy in the department of nephrology of the second hospital of Shanxi medical university,who were pathologically diagnosed as idiopathic membranous nephropathy,of the 113 cases that met the inclusion criteria,including 78 male patients and 35 female patients.The age fluctuated between 21 and 73 years old,with an average age of(48.18±13.11)years old.Twenty-seven cases were treated with TAC combined with glucocorticoid,24 cases were treated with CTX combined with glucocorticoid,and62 cases were treated with glucocorticoid alone.The patients were followed up,and the changes of urine protein quantification,urine routine and biochemical indexes within 24 hours before and after treatment,as well as the remission rate after 6 months of treatment were observed and recorded.Results:1.Comparison of baseline data:Before treatment,the 24-hour urinary protein levels of TAC group,CTX group and hormone group were [2.1(1.3,3.6),3.7(1.2,6.8),2.4(1.5,3.8)],total cholesterol [6.2(5.6,7.7),8.0(6.5,10.6),7.5(5.9,8.5)],triglyceride [2.2(2.0,3.0),3.0(1.9,4.4),2.4(1.9,3.2)],serum creatinine [(70.9±15.7),(72.6±14.2),(73.4±16.3)],kidney There were no significant differences in the glomerular filtration rate[(102.2±20.9),(98.8±18.0),(104.2±20.0)] levels(P> 0.01),and the serum albumin levels[27.4(21.7,36.4),22.8(20.2,26.4),24.9(18.3,35.9)] levels(P< 0.01).2.Renal function comparison results: after 3 months of treatment,serum creatinine[(77.4±13.0))in the TAC group was increased(P< 0.05),glomerular filtration rate[(86.8±18.3)] was decreased(P< 0.01),serum creatinine [(99.8±21.1)] and serum creatinine [(104.0±17.7)] in the CTX group were increased(P< 0.05)compared with that in the TAC group.After 6 months of treatment,the glomerular filtration rate of TAC group [(93.1±16.5)] was lower than that before treatment and at 3 months of treatment(P< 0.05).3.24 hours urinary protein quantitative and serum albumin comparison results:Treatment for 3 months,CTX and hormone group serum albumin [32.8(30.7,39.3),36.9(30.7,44.5)] increased(P< 0.01),earlier TAC group,CTX group and hormone group 24 hours urinary protein quantitative [1.2(0.8.1.8),1.2(0.4,2.1)and 1.6(0.5,2.8)] from the previous lower(P< 0.01),treatment for 6 months,the TAC group 24 hours urinary protein quantitative [0.9(0.5,1.5)] is lower than before treatment(P< 0.01),Serum albumin [39.1(38.1,42.3)] is higher than before and 3 months treatment(P< 0.01),serum albumin CTX group [37.5(33.2,41.5)] is higher than before treatment(P< 0.01),CTX group of 24 hours urinary protein quantitative [0.9(0.4,1.8)] is lower than before treatment(P< 0.01),serum albumin hormone group [42.7(37.2,46.3)] is higher than before treatment(P< 0.01)and the treatment for 3 months(P< 0.05),The 24-hour urinary protein ration in the hormone group [0.6(0.3,2.3)] was lower than that before treatment and 3 months after treatment(P< 0.01).4.Comparison results of blood lipids:Treatment for 6 months,the TAC group total cholesterol [5.1(4.4,6.6)] is lower than before treatment(P< 0.05),CTX group total cholesterol [6.3(4.7,7.5)] is lower than before treatment(P< 0.01),and triglycerides [2.3(1.9,2.7)] is lower than before treatment(P< 0.05),the hormone group total cholesterol[4.7(4.0,5.6)] is lower than before and 3 months treatment(P< 0.01),and triglycerides[1.9(1.7,2.7)] is lower than before and 3 months treatment(P< 0.05);5.The total remission rate of TAC group was 97.6%,which was significantly higher than that of CTX group(61.1%)and hormone group(70.7%)(P< 0.05).Conclusion:The effect of TAC combined with glucocorticoid on IMN was better than that of CTX combined with glucocorticoid and glucocorticoid alone. |
