目的 觀察對比他克莫司或來氟米特聯(lián)合潑尼松治療特發(fā)性膜性腎病的療效及安全性。方法 選取在榆林市第二醫(yī)院就診的經(jīng)腎活檢診斷為膜性腎病的80例患者，隨機(jī)分為觀察組（他克莫司+潑尼松）和對照組（來氟米特+潑尼松）各40例。對比兩組治療前后血清白蛋白、血糖、24 h尿蛋白定量、血清膽固醇、血清三酰甘油及血肌酐變化。結(jié)果 觀察組完全緩解和部分緩解各16例，無效8例，臨床緩解率80.00%；對照組完全緩解8例，部分緩解13例，無效19例，臨床緩解率52.50%。觀察組臨床緩解率明顯高于對照組（P<0.05）。兩組治療8周及24周24 h尿蛋白定量、三酰甘油均較治療前明顯降低（P<0.05）；兩組治療8周及24周時白蛋白較治療前明顯升高（P<0.05）。觀察組治療24周后24 h尿蛋白定量、三酰甘油均顯著低于對照組（P<0.05）；觀察組治療24周后白蛋白顯著高于照組（P<0.05）。兩組患者治療4、8、24周后血糖、血清肌酐變化無統(tǒng)計學(xué)意義。兩組不良反應(yīng)比較，差異無統(tǒng)計學(xué)意義。結(jié)論 他克莫司聯(lián)合激素治療特發(fā)性膜性腎病的效果較好，可延緩腎功能惡化，安全性好。

Objective To evaluate and compare the efficacy and safety of tacrolimus and leflunomide combined with hormone therapy for idiopathic membranous nephropathy. Methods Patients with membranous nephropathy diagnosed by renal biopsy in Yulin Second Hospital (80 cases) were randomly divided into observation group (tacrolimus+hormone) and control group (LEF+hormone), 40 cases in each group. The levels of serum albumin, blood glucose, 24 h urine protein, serum cholesterol, serum triglyceride, and serum creatinine before and after treatment in the two groups were compared. Results There were 16 cases of complete remission and 16 cases of partial remission, 8 cases inefficient in observation group. The clinical remission rate of observation group was 80%. There were 8 cases of complete remission and 13 cases of partial remission, 19 cases inefficient in control group. The clinical remission rate of control group was 52.50%, which was significantly higher than that of control group (P<0.05). After treatment of 8 weeks and 24 weeks, the 24 h urinary protein and triglycerides were significantly lower than those before treatment, and the difference was statistically significant (P<0.05). Two weeks and 24 weeks after treatment, 24 h urinary protein and triglyceride in two groups were significantly lower than those before treatment (P<0.05) and the serum albumin was significantly higher than before treatment (P<0.05). After 24 weeks treatment, 24 h urinary protein and triglyceride in the observation group were significantly lower than that in the control group (P<0.05), and the albumin was significantly higher than that in the control group (P<0.05). There was no significant change in blood glucose and serum creatinine in two groups after 4, 8, and 24 weeks treatment. The adverse reactions of the two groups were compared, the difference was not statistically significant. Conclusion The effect of tacrolimus combined with hormone therapy on idiopathic membranous nephropathy is better, which can delay the deterioration of renal function and the safety is good.