目的 探討小劑量潑尼松聯(lián)合他克莫司治療難治性腎病綜合征的臨床療效。方法 選擇2016年1月—2018年1月海南醫(yī)學(xué)院第二附屬醫(yī)院收治的難治性腎病綜合征患者80例，采用隨機(jī)數(shù)字表法分為觀察組與對(duì)照組，每組各40例。對(duì)照組口服他克莫司膠囊，50 μg/（kg·d），2次/d。觀察組在對(duì)照組的基礎(chǔ)上口服醋酸潑尼松片，0.75 mg/（kg·d），治療8周后每周逐漸減少10%的劑量，兩組均治療6個(gè)月。比較兩組患者的臨床療效，同時(shí)比較兩組患者治療前后的腎功能指標(biāo)、炎癥因子水平、血小板計(jì)數(shù)、尿蛋白、抗ds-DNA、補(bǔ)體C3和補(bǔ)體C4水平。結(jié)果 治療后，觀察組的治療有效率95.0%明顯高于對(duì)照組的85.0%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組24 h尿蛋白定量（24 hUPQ）、血肌酐（Scr）、胱抑素C（CysC）、尿素氮（BUN）水平均顯著降低（P<0.05）；觀察組治療后的24 h UPQ、Scr、CysC、BUN水平明顯低于對(duì)照組（P<0.05）。治療后，兩組腫瘤壞死因子-α（TNF-α）、白細(xì)胞介素-2（IL-2）、白細(xì)胞介素-6（IL-6）、白細(xì)胞介素-8（IL-8）水平均顯著降低（P<0.05）；觀察組治療后的TNF-α、IL-2、IL-6、IL-8水平明顯低于對(duì)照組（P<0.05）。治療后，兩組患者的血小板計(jì)數(shù)、尿蛋白、抗ds-DNA、補(bǔ)體C3和C4顯著優(yōu)于治療前（P<0.05）；且治療后，觀察組患者的血小板計(jì)數(shù)、補(bǔ)體C3、C4水平顯著高于對(duì)照組，尿蛋白、抗ds-DNA水平顯著低于對(duì)照組（P<0.05）。結(jié)論 小劑量潑尼松聯(lián)合他克莫司治療可有效改善難治性腎病綜合征患者的腎功能，抑制炎癥反應(yīng)，治療效果良好，值得推薦。

Objective To investigate the clinical efficacy of low dose prednisone combined with tacrolimus in treatment of refractory nephrotic syndrome. Methods A total of 80 patients with refractory nephrotic syndrome admitted to Second Affiliated Hospital of Hainan Medical College from January 2016 to January 2018 were randomly divided into observation group and control group, each groups had 40 cases. The control group were po administered with Tacrolimus Capsules, 50 μg/(kg·d), twice daily. And the observation group were po administered with Prednisone Acetate Tablets on the basis of control group, 0.75 mg/(kg·d), and gradually reduced the dose by 10% per week after 8 weeks of treatment. Both groups were treated for 6 months. The clinical efficacy of the two groups was compared, and the renal function indicators, inflammatory factor levels, platelet count, urine protein, anti dsDNA, complement C3 and complement C4 levels in two groups before and after treatment were also compared. Results After treatment, the effective rate in the observation group was 95.0%, which was significantly higher than 85.0% in the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, 24 hUPQ, Scr, CysC, and BUN levels in two group were significantly decreased (P<0.05). After treatment, 24 hUPQ, Scr, CysC, and BUN levels in the observation group were significantly lower than those in the control group (P<0.05). After treatment, TNF-α, IL-2, IL-6 and IL-8 levels in two group were significantly decreased (P<0.05). After treatment, the levels of TNF-α, IL-2, IL-6 and IL-8 in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the platelet count, urine protein, anti ds-DNA, complement C3 and C4 in two groups were significantly better than those before treatment (P<0.05). After treatment, the levels of platelet count, complement C3 and C4 in the observation group were significantly higher than those in the control group, and the levels of urine protein and anti ds-DNA were significantly lower than those in the control group (P<0.05). Conclusion Low dose prednisone combined with tacrolimus can effectively improve the renal function of patients with refractory nephrotic syndrome, inhibit the inflammatory response, the treatment effect is good, it is worth recommending.

R983

海南省自然科學(xué)基金資助項(xiàng)目（814342）