Objective To observe the efficacy of calcineurin inhibitors in the treatment of the simple and the refractory idiopathic membranous nephropathy.Methods Seventy-two patients with id-iopathic membranous nephropathy and regularly followed up in Changzheng Hospital of the Second Military Medical University were enrolled.There were 33 patients without remission after 6 months of angiotension conversion enzyme inhibitor or angiotensin receptor blocker,and 39 patients without re-mission after 6 months of cyclophosphamiddum.These outpatients were regularly followed up with 24-h urinary protein,plasma albumin,serum creatinine,blood urea nitrogen,uric acid,cholesterol,tri-glyceride and blood concentration of calcineurin inhibitors.The therapeutic response of calcineurin in-hibitors and the remission and recurrence rate of idiopathic membranous nephropathy were observed. The follow-up duration was 6 to 12 months.Results Of the 33 patients who received first immunosup-pressive treatment,the cyclosporine A group had significant remission of 24-h urinary protein (F=36.36,P<0.000 1),plasma albumin (F=20.81,P<0.000 1)and plasma cholesterol (F=15.35, P=0.001 5),and the tacrolimus group also had significant remission of 24-h urinary protein (F=40.06,P<0.01),plasma albumin (F=34.42,P<0.000 1)and plasma cholesterol (F=23.15,P<0.000 1).Of the 39 patients who have received cyclophosphamiddum treatment,the cyclosporine A group had significant remission of 24-h urinary protein (F=46.6,P<0.000 1 )and plasma albumin (F=25.57,P<0.000 1),and the tacrolimus group also had significant remission of 24-h urinary protein (F=51.5,P<0.000 1)and plasma albumin (F=31.62,P<0.000 1).The remission rate was increased with time,but no significant difference was found between the two groups (P>0.05). Conclusions The calcineurin inhibitors combined with low-dose prednisolone treatment can be effec-tive for either the simple idiopathic membranous nephropathy or the refractory idiopathic membranous nephropathy.The difference between the two kinds of calcineurin inhibitors has no statistically signifi-cant difference.The adverse reaction can be low-graded and regulated.%目的：探讨钙调神经磷酸酶抑制剂对首诊特发性膜性肾病(idiopathic membranous ne-phropathy,IMN)和难治性 IMN患者的有效性。方法回顾性分析第二军医大学长征医院肾内科确诊并常规随访的 IMN患者72例,其中33例为经血管紧张素转换酶抑制剂(angiotension conversion enzyme inhibitor,ACEI)或血管紧张素受体拮抗剂(angiotensin receptor blocker,ARB)等保守治疗6个月未缓解的首诊 IMN患者,39例为经环磷酰胺治疗6个月未缓解的难治性 IMN 患者。门诊定期随访其患者24 h尿蛋白定量、血白蛋白、血肌酐、尿素氮、尿酸、血胆固醇、三酰甘油、环孢素 A(cyclos-porine A,CsA)和他克莫司(tacrolimus,FK-506)浓度等指标,分析其对钙调神经磷酸酶抑制剂的治疗反应并对患者的缓解率及复发率进行观察。随访时间为6~12个月。结果首诊 IMN 患者中,CsA组治疗后第3、6及12个月时,24 h尿蛋白定量(F=36.36,P<0.0001)、血白蛋白水平(F=20.81,P<0.0001)、血总胆固醇(F=15.35,P=0.0015)分别较治疗前明显好转；FK-506组治疗后第3、6及12个月时,24 h尿蛋白定量(F=40.06,P<0.01)、血白蛋白水平(F=34.42,P<0.0001)、血总胆固醇(F=23.15,P<0.0001)分别较治疗前也明显好转。难治性 IMN患者中,CsA 组治疗后第3、6及12个月时,24 h尿蛋白定量(F=46.6,P<0.0001)和血白蛋白(F=25.57,P<0.0001)分别明显好转；FK-506组治疗后第3、6及12个月时,24 h尿蛋白定量(F=51.5,P<0.0001)和血白蛋白(F=31.62,P<0.0001)亦分别明显好转。缓解率随治疗时间延长而增长,但环孢素 A 及他克莫司在肾病缓解方面的差异无统计学意义(P>0.05)。结论钙调神经磷酸酶抑制剂联合小剂量激素不仅对首诊 IMN有效,对环磷酰胺无效的难治性 IMN仍有效,且两类钙调神经磷酸酶抑制剂在治疗效果方面差异无统计学意义,不良反应发生率较低且可调控。
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