他克莫司对特发性膜性肾病患者血清M型磷脂酶A2受体、1型血小板反应蛋白7A域表达的影响
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摘要
目的:探讨他克莫司对特发性膜性肾病患者血清M型磷脂酶A2受体(PLA2R)和1型血小板反应蛋白7A域(THSD7A)表达的影响。方法:选取2016年3月至2018年3月河北工程大学附属医院收治的特发性膜性肾病患者120例,根据患者选择的治疗方案分为观察组和对照组,每组60例。观察组患者采用他克莫司联合糖皮质激素治疗,对照组患者采用环磷酰胺联合糖皮质激素治疗。观察两组患者的临床疗效,治疗前后各临床指标水平、血清PLA2R和THSD7A表达情况及不良反应发生情况。结果:观察组患者的总缓解率为61.7%(37/60),明显高于对照组的41.7%(25/60),差异有统计学意义(P<0.05)。治疗后,两组患者24 h尿蛋白量、三酰甘油及总胆固醇水平较治疗前明显降低,血清白蛋白水平较治疗前明显升高,且观察组患者上述指标水平明显优于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患者PLA2R、THSD7A阳性率明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者不良反应发生率为3.3%(2/60),明显低于对照组的16.7%(10/60),差异有统计学意义(P<0.05)。结论:他克莫司有助于提高特发性膜性肾病的缓解率,降低PLA2R和THSD7A的表达,且不良反应少。
OBJECTIVE: To investigate the effects of tacrolimus on serum M-type phospholipase A2 receptor(PLA2 R) and thrombospondin type-1 domain-containing 7 A(THSD7 A) expression in patients with idiopathic membranous nephropathy. METHODS: Totally 120 patients with idiopathic membranous nephropathy admitted into Affiliated Hospital of Hebei University of Engineering from Mar. 2016 to Mar. 2018 were extracted to be divided into the observation group and the control group via the random number table, with 60 cases in each group. Patients in the observation group were treated with tacrolimus combined with glucocorticoid, while the control group received cyclophosphamide combined with glucocorticoid. The clinical efficacy, levels of clinical indicators, serum PLA2 R and THSD7 A expression before and after treatment and adverse drug reactions of two groups were observed. RESULTS: The overall response rate of the observation group was 61.7%(37/60), significantly higher than that of the control group [41.7%(25/60)], the difference was statistically significant(P<0.05). After treatment, the 24 h urine protein, triglyceride and total cholesterol levels of two groups decreased significantly compared with before treatment, and the serum albumin levels increased significantly compared with before treatment, the above indicators were significantly better in the observation group than in the control group, with statistically significant difference(P<0.05). After treatment, the positive rate of PLA2 R and THSD7 A in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The incidence of adverse drug reactions in the observation group was 3.3%(2/60), significantly lower than that in the control group [16.7%(10/60)], and the difference was statistically significant(P<0.05). CONCLUSIONS: Tacrolimus can help to improve the remission rate of idiopathic membranous nephropathy, reduce the expression of PLA2 R and THSD7 A, and has fewer adverse drug reactions.
OBJECTIVE: To investigate the effects of tacrolimus on serum M-type phospholipase A2 receptor(PLA2 R) and thrombospondin type-1 domain-containing 7 A(THSD7 A) expression in patients with idiopathic membranous nephropathy. METHODS: Totally 120 patients with idiopathic membranous nephropathy admitted into Affiliated Hospital of Hebei University of Engineering from Mar. 2016 to Mar. 2018 were extracted to be divided into the observation group and the control group via the random number table, with 60 cases in each group. Patients in the observation group were treated with tacrolimus combined with glucocorticoid, while the control group received cyclophosphamide combined with glucocorticoid. The clinical efficacy, levels of clinical indicators, serum PLA2 R and THSD7 A expression before and after treatment and adverse drug reactions of two groups were observed. RESULTS: The overall response rate of the observation group was 61.7%(37/60), significantly higher than that of the control group [41.7%(25/60)], the difference was statistically significant(P<0.05). After treatment, the 24 h urine protein, triglyceride and total cholesterol levels of two groups decreased significantly compared with before treatment, and the serum albumin levels increased significantly compared with before treatment, the above indicators were significantly better in the observation group than in the control group, with statistically significant difference(P<0.05). After treatment, the positive rate of PLA2 R and THSD7 A in the observation group was significantly lower than that in the control group, and the difference was statistically significant(P<0.05). The incidence of adverse drug reactions in the observation group was 3.3%(2/60), significantly lower than that in the control group [16.7%(10/60)], and the difference was statistically significant(P<0.05). CONCLUSIONS: Tacrolimus can help to improve the remission rate of idiopathic membranous nephropathy, reduce the expression of PLA2 R and THSD7 A, and has fewer adverse drug reactions.
引文
[1] 付云飞,王蓉辉,解汝娟,等.特发性膜性肾病相关抗原的研究进展[J].临床与病理杂志,2019,39(2):424-428.
[2] 刘敏,庄永泽.PLA2R和THSD7A及其抗体在特发性膜性肾病中的研究进展[J].中国中西医结合肾病杂志,2018,19(11):1018-1020.
[3] Cattran DC,Brenchley PE.Membranous nephropathy:integrating-basic science into improved clinical management[J].Kidney Int,2017,91(3):566-574.
[4] Yusuf MG,Das BB,Shaha AC,et al.Histopathological types in adult nephrotic syndrome[J].Saudi J Kidney Dis Transpl,2016,27(3):576-580.
[5] 李媛,焦军东.PLA2R1相关性特发性膜性肾病的诊治进展[J].中国中西医结合肾病杂志,2019,20(1):93-94.
[6] 毛文丽,杜琳娜,张真真,等.他克莫司或环磷酰胺联合糖皮质激素治疗特发性膜性肾病的疗效比较[J].临床肾脏病学杂志,2018,18(12):756-760.
[7] 周广宇,郭莹,张力,等.他克莫司联合激素治疗特发性膜性肾病疗效及其抗PLA2R抗体对治疗的反应[J].吉林大学学报:医学版,2016,42(5):937-941.
[8] 王桃霞.M型磷脂酶A2受体和1型血小板反应蛋白7A域的表达与特发性膜性肾病患者病情及临床预后的关系[J].解放军预防医学杂志,2019,37(2):85-86,89.
[9] Pourcine F,Dahan K,Mihout F,et al.Prognostic value of PLA2R autoimmunity detected by measurement of anti-PLA2R antibodies com-bined with detection of PLA2R antigen in membranous nephro-pathy:A single-centre study over 14 years[J].PLoS One,2017,12(3):e0173201.
[10] Kronbichler A,Oh J,Meijers B,et al.Recent progress in deciphering the etiopathogenesis of primary membranous nephropathy[J].Biomed Res Int,2017:1936372.
[11] 邱明珠,郑智勇.原发性膜性肾病研究新进展[J].临床与实验病理学杂志,2018,34(8):889-892.
[12] 温丽颖.M型磷脂酶A2受体及1型血小板反应蛋白7A域在成人特发膜性肾病的表达及其意义[D].石家庄:河北医科大学,2016.
[13] 徐军.环磷酰胺与他克莫司治疗特发性膜性肾病的比较[J].中国卫生标准管理,2019,10(02):92-94.
[14] 庞婕,顾永丽,高山,等.他克莫司与环磷酰胺治疗特发性膜性肾病的系统评价[J].中国医院用药评价与分析,2016,16(4):501-505.
[15] 符克英,蔡俊宏,符生苗,等.抗磷脂酶A2受体抗体检测在老年人特发性膜性肾病肾组织及血液中的表达[J].中国老年学杂志,2016,36(17):4281-4283.
[16] 王莉君,尚明花,诸葛一峰,等.特发性膜性肾病患者肾组织PLA2R的表达及其与免疫治疗疗效关系的初步探讨[J].中华医学杂志,2016,96(1):4-8.
[17] 温丽颖,李绍梅,闫喆,等.M型磷脂酶A2受体及1型血小板反应蛋白7A域在成人特发性膜性肾病的表达及其意义[J].中华肾脏病杂志,2016,32(8):561-567.
[2] 刘敏,庄永泽.PLA2R和THSD7A及其抗体在特发性膜性肾病中的研究进展[J].中国中西医结合肾病杂志,2018,19(11):1018-1020.
[3] Cattran DC,Brenchley PE.Membranous nephropathy:integrating-basic science into improved clinical management[J].Kidney Int,2017,91(3):566-574.
[4] Yusuf MG,Das BB,Shaha AC,et al.Histopathological types in adult nephrotic syndrome[J].Saudi J Kidney Dis Transpl,2016,27(3):576-580.
[5] 李媛,焦军东.PLA2R1相关性特发性膜性肾病的诊治进展[J].中国中西医结合肾病杂志,2019,20(1):93-94.
[6] 毛文丽,杜琳娜,张真真,等.他克莫司或环磷酰胺联合糖皮质激素治疗特发性膜性肾病的疗效比较[J].临床肾脏病学杂志,2018,18(12):756-760.
[7] 周广宇,郭莹,张力,等.他克莫司联合激素治疗特发性膜性肾病疗效及其抗PLA2R抗体对治疗的反应[J].吉林大学学报:医学版,2016,42(5):937-941.
[8] 王桃霞.M型磷脂酶A2受体和1型血小板反应蛋白7A域的表达与特发性膜性肾病患者病情及临床预后的关系[J].解放军预防医学杂志,2019,37(2):85-86,89.
[9] Pourcine F,Dahan K,Mihout F,et al.Prognostic value of PLA2R autoimmunity detected by measurement of anti-PLA2R antibodies com-bined with detection of PLA2R antigen in membranous nephro-pathy:A single-centre study over 14 years[J].PLoS One,2017,12(3):e0173201.
[10] Kronbichler A,Oh J,Meijers B,et al.Recent progress in deciphering the etiopathogenesis of primary membranous nephropathy[J].Biomed Res Int,2017:1936372.
[11] 邱明珠,郑智勇.原发性膜性肾病研究新进展[J].临床与实验病理学杂志,2018,34(8):889-892.
[12] 温丽颖.M型磷脂酶A2受体及1型血小板反应蛋白7A域在成人特发膜性肾病的表达及其意义[D].石家庄:河北医科大学,2016.
[13] 徐军.环磷酰胺与他克莫司治疗特发性膜性肾病的比较[J].中国卫生标准管理,2019,10(02):92-94.
[14] 庞婕,顾永丽,高山,等.他克莫司与环磷酰胺治疗特发性膜性肾病的系统评价[J].中国医院用药评价与分析,2016,16(4):501-505.
[15] 符克英,蔡俊宏,符生苗,等.抗磷脂酶A2受体抗体检测在老年人特发性膜性肾病肾组织及血液中的表达[J].中国老年学杂志,2016,36(17):4281-4283.
[16] 王莉君,尚明花,诸葛一峰,等.特发性膜性肾病患者肾组织PLA2R的表达及其与免疫治疗疗效关系的初步探讨[J].中华医学杂志,2016,96(1):4-8.
[17] 温丽颖,李绍梅,闫喆,等.M型磷脂酶A2受体及1型血小板反应蛋白7A域在成人特发性膜性肾病的表达及其意义[J].中华肾脏病杂志,2016,32(8):561-567.