The Efficacy Of Tacrolimus Or Cyclophosphamide Combined With Glucocorticoids In The Treatment Of Idiopathic Membranous Nephropathy

Objective:To observe the clinical efficacy and safety of Tacrolimus or Cyclophosphamide combined with glucocorticoids in treatment of idiopathic membranous nephropathy.Methods:A retrospective study was conducted in 46 patients who had been diagnosed with idiopathic membranous nephropathy from September 2016 to June 2017 in Qianfoshan Hospital of Shandong Province.The patients were followed up for 36 weeks.Divided the patients into two groups,27 patients were given tacrolimus(TAC)combined with gluco-corticoid group(test group).Tacrolimus started with a dose of 0.03~0.05mg/kg/d,divided into 2 daily doses.The plasma concentration of TAC was maintained at 5~10 ng/ml for the first 6 months,and then the concentration was 3~5ng/ml at 3 months.Others given cyclophosphamide(CTX)combined glucocorticoid group(control group),cyclophosph-amide dosages is 750mg/m~2,add 100 ml saline intravenous drip in 2 hours,physiological saline to 250ml+vitamin B6 0.3g intravenous drip water injection,once a month,for six months,the cumulative CTX dose not more than 9g.Both groups were given prednisone0.5mg/(kg.d),and tapered gradually to discontinued.Serum urinary protein,serum albumin,serum creatinine,fasting blood glucose,triglyceride,total cho-lesterol levels and the rate of remission were observed and recorded in the two groups.Compared the difference between the two treatment methods.Results:There were no significant differences in general data(gender,age,course of illness)and laboratory tests before entry into the two groups(P>0.05).After 36 weeks of treatment,16 cases(59.25%)were completely remission in the test group and 7 cases(36.84%)were completely relieved in the control group.The complete remission rate in the test group was higher than that in the control group(P<0.01).8 cases(29.63%)in the test group,and in the control group,partial remission was observed in 8 cases(42.11%).The test group was ineffective in 3 cases(11.11%),the control group was ineffective in 4 cases(21.05%).The24-hour urinary protein quantification was significantly relieved in the two groups(P<0.05).The 24-hour urinary protein quantification of the test group decreased from(10.07±3.24)g/24 h to(1.16±2.60)g/24 h(P<0.01),while the control group decreased from(8.60±3.83)g/24h to(1.71±2.67)g/24h(P<0.01),the difference was statistically significant;the serum albumin level was also significantly higher than before;the serum of the test group albumin levels increased from(22.29±3.65)g/l to(42.96±3.30)g/l(P<0.01);controls increased from(23.52±4.53)g/l to(40.89±6.14)g/l(P<0.01),the difference was statistically significant.There was no significant change in serum creatinine,blood glucose,triglyceride,total cholesterol during the treatment in both groups,and the difference was not statistically significant(P>0.05).During the course of treatment,no serious adverse reactions such as myelosuppression occurred in both groups of patients.Conclusion:Tacrolimus combined with glucocorticoid is effective and safe in the treatment of idiopathic membranous nephropathy.Compared with cyclophosphamide,tacrolimus can rapidly relieve urinary protein,and the remission rate is better than cyclophosphamide.