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目的观察特发性膜性肾病(IMN)患者足突宽度(FPW)与尿蛋白量(Upro)和他克莫司方案治疗反应的关系。方法选取2015年6月至2016年3月新乡医学院第一附属医院确诊为IMN患者34例,根据患者FPW中位数将患者分为轻度足突融合组(FPW≤2 200 nm)12例和重度足突融合组(FPW>2 200 nm)22例,患者均应用他克莫司方案进行治疗6个月。观察患者FPW与Upro的相关性;不同FPW组患者应用他克莫司治疗后的临床疗效。结果34例IMN患者平均FPW为(2 579.90±994.50)nm,FPW与Upro存在显著正相关(r=0.607,P<0.001)。轻度足突融合组患者平均FPW为(1 776.30±560.20)nm,24 h Upro为(2.10±0.70)g;重度足突融合组患者FPW为(2 914.80±947.90)nm,24 h Upro为(6.50±2.20)g;重度足突融合组患者FPW和24 h Upro均较高于轻度足突融合组(P<0.05)。治疗后,轻度足突融合组患者12例中完全缓解(CR)4例(33.3%),部分缓解(PR)2例(16.7%),无效(NR)6例(50.0%),治疗总缓解率50.0%(6/12);重度足突融合组患者22例中CR 7例(32.4%),PR 12例(41.2%),NR 3例(26.5%),治疗总缓解率86.3%(19/22);重度足突融合组患者治疗总缓解率显著高于轻度足突融合组(χ~2=6.801,P<0.05)。结论足突融合参与尿蛋白的发生,其严重程度决定了Upro的多少;他克莫司对于严重足突融合的患者治疗效果较好,这类患者在治疗方案上应优先选择他克莫司。
Objective To investigate the relationship between FPW and Upro in treatment of idiopathic membranous nephropathy (IMN) and tacrolimus regimen. Methods From June 2015 to March 2016, 34 cases of IMN were diagnosed in the First Affiliated Hospital of Xinxiang Medical College. According to the FPW median, patients were divided into mild foot protrusion fusion group (FPW≤2 200 nm) in 12 cases And severe foot process fusion group (FPW> 2 200 nm), 22 patients were treated with tacrolimus for 6 months. The correlation between FPW and Upro was observed. The clinical efficacy of tacrolimus in different FPW patients was observed. Results The average FPW of 34 patients with IMN was (2 579.90 ± 994.50) nm, FPW had a significant positive correlation with Upro (r = 0.607, P <0.001). The average FPW in mild fusion group was (1776.30 ± 560.20) nm, and that in 24 h (2.10 ± 0.70) g FP FP was (2914.80 ± 947.90) nm in 24 h and 6.50 ± 2.20) g respectively; FPW and 24 h Upro in patients with severe foot process were higher than those in mild foot process (P <0.05). After treatment, 4 cases (33.3%) of complete remission (CR), partial remission (PR) 2 cases (16.7%) and ineffective (NR) 6 cases (50.0% The response rate of CR was 50.0% (6/12) in 7 cases (32.4%), PR 12 cases (41.2%) and NR 3 cases (26.5%), and the total response rate was 86.3% 19/22). The total remission rate of patients with severe foot process fusion was significantly higher than that of mild foot process (χ ~ 2 = 6.801, P <0.05). Conclusion Foot process fusion involved in the occurrence of urinary protein, the severity of which determines the number of Upro; Tacrolimus in patients with severe foot fusion better treatment, such patients should be preferred in the treatment of tacrolimus.