目的 研究甲潑尼龍分別聯(lián)合環(huán)磷酰胺與他克莫司對狼瘡性腎炎患者的療效及安全性。方法 選取2015年3月—2018年3月在榆林市第二醫(yī)院就診的80例狼瘡性腎炎患者為研究對象，隨機分為對照組39例和觀察組41例。所有患者均給予甲潑尼龍治療，在此基礎(chǔ)上對照組患者給予注射用環(huán)磷酰胺治療，劑量為0.5 g/m2，不超過9 g，1次/2周；觀察組患者給予他克莫司膠囊治療，誘導期初始劑量為4 mg/d，2次/d，間隔12 h，餐后2 h服用，監(jiān)測血藥谷濃度，維持在5～8 ng/mL，連續(xù)治療4～8周后，維持期劑量保持2 mg/d，血藥谷濃度維持在2～5 ng/mL。比較兩組患者的臨床療效，治療前后的相關(guān)臨床指標變化情況以及治療期間的不良反應(yīng)發(fā)生情況。結(jié)果 治療后，觀察組患者的總有效率為87.80%，顯著高于對照組的66.67%，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療前兩組各項指標差異不顯著，治療后兩組24 h尿蛋白量、血清抗核抗體（ANA）陽性率、血清肌酐（SCr）、紅斑狼瘡活動指數(shù)評分（SLEDAI）均降低，補體C3水平升高，同組治療前后比較差異有統(tǒng)計學意義（P<0.05）；且觀察組變化顯著優(yōu)于對照組，組間差異有統(tǒng)計學意義（P<0.05）。治療期間，觀察組不良反應(yīng)總發(fā)生率為7.32%，顯著低于對照組的17.95%（P<0.05）。結(jié)論 甲潑尼龍聯(lián)合他克莫司治療狼瘡性腎炎療效顯著，能有效改善患者的相關(guān)臨床指標，且具有較高的安全性，值得在臨床推廣使用。

Objective To investigate the clinical effect and safety of methylprednisolone combined with cyclophosphamide and tacrolimus respectively in patients with lupus nephritis. Methods Selected 80 cases of patients with lupus nephritis who were treated in The Second Hospital of Yunlin from March 2015 to March 2018, divided into observation group (41 cases) and control group (39 cases) randomly. All patients were treated with methylprednisolone, patients in the control group were treated with Cyclophosphamide for Injection at a dose of 0.5 g/m², no more than 9 g, once/2 weeks. Patients in the observation group were treated with Tacrolimus Capsules at an initial dose of 4 mg/d, twice daily, 12 h apart, 2 hours after meal, and the blood trough concentration was monitored to maintain at 5-8 ng/mL for 4-8 consecutive treatments. The maintenance dose was maintained at 2 mg/d and the blood trough concentration was maintained at 2-5 ng/mL. Clinical effects, changes of related clinical indicators before and after treatment and the adverse reactions occur during treatment were compared between two groups. Results After treatment, the total effective rate of the observation group was 87.80%, which was significantly higher than 66.67% in the control group (P<0.05). There were no significant differences in the indicators of two groups before the treatment, and the 24 h urine protein amount, ANA positive rate, Scr, and SLEDAI scores were decreased after the treatment, and the level of C3 were increased, and there were differences in the same group (P<0.05). And the changes in observation group were significantly better than control group, and there were differences between two groups (P<0.05). The incidence of adverse reactions in the observation group during treatment was 7.32%, which was significantly lower than 17.95% in the control group (P<0.05). Conclusion Methylprednisolone combined with tacrolimus was effective in treatment of lupus nephritis, which can effectively improve the related clinical indicators of patients, and has a higher safety, is worthy of clinical application.