Comparison of tripterygium wilfordii multiglycosides and tacrolimus in the treatment of idiopathic membranous nephropathy: a prospective cohort study.
Comparison of tripterygium wilfordii multiglycosides and tacrolimus in the treatment of idiopathic membranous nephropathy: a prospective cohort study.
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DOI：
10.1186/s12882-015-0199-x
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发表时间：
2015-12-04
期刊：
影响因子：
2.3
通讯作者：
Chen J
中科院分区：
文献类型：
--
作者：
Liu S;Li X;Li H;Liang Q;Chen J;Chen J
特发性膜性肾病（IMN）是成人肾病综合征的主要病因。考虑到IMN的自然病程，需要仔细考虑此类患者何时治疗以及采用何种免疫抑制治疗。雷公藤多苷（TWG）和泼尼松的组合可能是治疗IMN患者的有效选择。在这项前瞻性队列研究中，我们在我们的肾脏中心招募了经活检证实的IMN患者。一个队列接受TWG联合泼尼松，而另一个队列接受他克莫司（TAC）联合泼尼松，持续36周。主要结局是缓解率，而次要结局包括缓解时间、复发率、血清白蛋白水平和每日尿蛋白水平的变化、估计的肾小球滤过率和不良事件。共有53例IMN患者符合入组标准，所有患者均完成了治疗。在36周的治疗结束时，20例患者观察到部分缓解[PR]或完全缓解[CR] TWG组86.9%，TWG组27例TWG组和TAC组分别有12例（52.2%）和14例（46.7%）获得完全缓解（p > 0.05）。TWG和TAC组的缓解概率相似（p > 0.05，对数库检验）。TWG组达到缓解的平均时间为11.8 ± 12.5周，TAC组为8.5 ± 9.1周（p > 0.05）。TWG联合泼尼松治疗IMN安全有效。
Idiopathic membranous nephropathy (IMN) is a major cause of nephrotic syndrome among adults. Considering the natural course of IMN, when to treat and with which immunosuppressive treatment need to be carefully considered in such patients. A combination of tripterygium wilfordii multiglycosides (TWG) and prednisone may be an effective option for treating patients with IMN. In this prospective cohort study, we enrolled patients with biopsy-proven IMN at our kidney centre. One cohort received TWG combined with prednisone, whereas another cohort received tacrolimus (TAC) combined with prednisone, for 36 weeks. The primary outcome was the remission rate, whereas the secondary outcomes included the time to remission, relapse rate, changes in serum albumin levels and daily urinary protein levels, estimated glomerular filtration rate, and adverse events. A total of 53 patients with IMN met the criteria for enrolment, and all patients completed the therapy. At the end of the 36-week therapy, remission (either partial remission [PR] or complete remission [CR]) was observed in 20 patients (86.9 %) receiving TWG and in 27 patients (90.0 %) receiving TAC (p > 0.05), whereas CR was noted in 12 patients (52.2 %) receiving TWG and 14 patients (46.7 %) receiving TAC (p > 0.05). The probability of remission was similar for both the TWG and TAC groups (p > 0.05, by log-bank test). The mean time for achieving remission was 11.8 ± 12.5 weeks in the TWG group and 8.5 ± 9.1 weeks in the TAC group (p > 0.05). The combination of TWG and predisone is an effective and safe therapy for IMN.