切换至 "中华医学电子期刊资源库"

中华肾病研究电子杂志 ›› 2018, Vol. 07 ›› Issue (04) : 186 -189. doi: 10.3877/cma.j.issn.2095-3216.2018.04.011

所属专题: 文献

综述

他克莫司治疗难治性肾病综合征的新进展
王化英1, 周广宇1,(), 王艺璇1, 郭莹1, 尹敏1, 吴晨1   
  1. 1. 130033 长春,吉林大学中日联谊医院肾内科
  • 收稿日期:2017-11-24 出版日期:2018-08-28
  • 通信作者: 周广宇
  • 基金资助:
    吉林省科技厅自然基金项目(20160101059JC); 国家自然科学基金面上项目(81370810); 横向课题项目(2017YX301)

Progress of treatment for refractory nephrotic syndrome with tacrolimus

Huaying Wang1, Guangyu Zhou1,(), Yixuan Wang1, Ying Guo1, Min Yin1, Chen Wu1   

  1. 1. Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
  • Received:2017-11-24 Published:2018-08-28
  • Corresponding author: Guangyu Zhou
  • About author:
    Corresponding author: Zhou Guangyu, Email:
引用本文:

王化英, 周广宇, 王艺璇, 郭莹, 尹敏, 吴晨. 他克莫司治疗难治性肾病综合征的新进展[J]. 中华肾病研究电子杂志, 2018, 07(04): 186-189.

Huaying Wang, Guangyu Zhou, Yixuan Wang, Ying Guo, Min Yin, Chen Wu. Progress of treatment for refractory nephrotic syndrome with tacrolimus[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(04): 186-189.

难治性肾病综合征约占原发性肾病综合征的30%~50%,包括激素依赖型、激素抵抗型和频复发型,具有病程长、易复发等特点。若得不到合理治疗可导致疾病难以缓解,并可能出现严重并发症,甚至进展为不可逆性慢性肾衰竭,极大影响患者生存质量,并威胁生命。目前,难治性肾病综合征患者多加用免疫抑制剂治疗,以糖皮质激素联合烷化剂较为经典,但其潜在的性腺毒性、骨髓抑制及致癌等不良反应限制了临床应用。近年,国内外应用新型免疫抑制剂他克莫司在治疗难治性肾病综合征中取得了较好疗效,本文就他克莫司治疗难治性肾病综合征的疗效及安全性方面的新进展做一综述。

Refractory nephrotic syndrome accounts for about 30%-50% of primary nephrotic syndrome, including steroid-dependent nephrotic syndrome, steroid-resistant nephrotic syndrome, and frequent relapse nephrotic syndrome, with characteristics of long durations and easy relapses. If the state of disease cannot be controlled with proper treatment, it might progress to chronic renal failure even with serious complications which greatly affects the patients′ quality of life and might be life-threatening. Although immunosuppressive therapies such as corticosteroids plus alkylating agents have been adopted as classic regimens, the potential gonadal toxicity, bone marrow suppression, and carcinogenic adverse effects limit their clinical applications. In recent years, tacrolimus, a novel immunosuppressive agent, has shown relatively good effects in the treatment of refractory nephrotic syndrome at home and abroad. This article presented the new progress in the efficacy and safety of tacrolimus for the treatment of refractory nephrotic syndrome.

[1]
叶腾,吕吟秋,陈波,等. 温州市成人原发性肾小球疾病病理类型构成比20年演变[J]. 温州医科大学学报,2015, 45(8): 574-578.
[2]
Nonaka K, Ubara Y, Suwabe T, et al. Intractable membranous lupus nephritis showing selective improvement of subepithelial deposits with tacrolimus therapy: a case report [J]. Clin Nephrol, 2013, 80(2): 140-145.
[3]
Faul C, Donnelly M, Merscher-Gomez S, et al. The actin cytoskeleton of kidney podocytes is a direct target of the antiproteinuric effect of cyclosporine A [J]. Nat Med, 2008, 14(9): 931-938.
[4]
McCauley J, Tzakis AG, Fung JJ, et al. FK506 in steroid-resistant focal sclerosing glomerulonephritis of childhood [J]. Lancet, 1990, 335(8690): 674.
[5]
Chen W, Liu Q, Liao Y, et al. Outcomes of tacrolimus therapy in adults with refractory membranous nephrotic syndrome: a prospective, multicenter clinical trial [J]. Am J Med Sci, 2013, 345(2): 81-87.
[6]
He L, Peng Y, Liu H, et al. Treatment of idiopathic membranous nephropathy with combination of low-dose tacrolimus and corticosteroids [J]. J Nephrol, 2013, 26(3): 564-571.
[7]
Praga M, Barrio V, Juárez GF, et al. Tacrolimus monotherapy in membranous nephropathy: a randomized controlled trial [J]. Kidney Int, 2007, 71(9): 924-930.
[8]
Fan L, Liu Q, Liao Y, et al. Tacrolimus is an alternative therapy option for the treatment of adult steroid-resistant nephrotic syndrome: a prospective, multicenter clinical trial [J]. Int Urol Nephrol, 2013, 45(2): 459-468.
[9]
Cui W, Lu X, Min X, et al. Therapy of tacrolimus combined with corticosteroids in idiopathic membranous nephropathy [J]. Braz J Med Biol Res, 2017, 50(4): e5976.
[10]
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.
[11]
Zhu LB, Liu LL, Yao L, et al. Efficacy and safety of tacrolimus versus cyclophosphamide for primary membranous nephropathy: a meta-analysis [J]. Drugs, 2017, 77(2): 187-199.
[12]
Santosh T, Liu H, Liu B. Effect of tacrolimus in idiopathic membranous nephropathy: a meta-analysis [J]. Chin Med J (Engl), 2014, 127(14): 2693-2699.
[13]
Xu D, Gao X, Bian R, et al. Tacrolimus improves proteinuria remission in adults with cyclosporine A-resistant or -dependent minimal change disease [J]. Nephrology (Carlton), 2017, 22(3): 251-256.
[14]
Wang W, Xia Y, Mao J, et al. Treatment of tacrolimus or cyclosporine A in children with idiopathic nephrotic syndrome [J]. Pediatr Nephrol, 2012, 27(11): 2073-2079.
[15]
Sinha A, Gupta A, Kalaivani M, et al. Mycophenolate mofetil is inferior to tacrolimus in sustaining remission in children with idiopathic steroid-resistant nephrotic syndrome [J]. Kidney Int, 2017, 92(1): 248-257.
[16]
Hannah J, Casian A, D′Cruz D. Tacrolimus use in lupus nephritis: a systematic review and meta-analysis [J]. Autoimmun Rev, 2016, 15(1): 93-101.
[17]
Li X, Xu N, Li H, et al. Tacrolimus as rescue therapy for adult-onset refractory minimal change nephrotic syndrome with reversible acute renal failure [J]. Nephrol Dial Transplant, 2013, 28(9): 2306-2312.
[18]
Roberti I, Vyas S. Long-term outcome of children with steroid-resistant nephrotic syndrome treated with tacrolimus [J]. Pediatr Nephrol, 2010, 25(6): 1117-1124.
[19]
Yuan H, Liu N, Sun GD, et al. Effect of prolonged tacrolimus treatment in idiopathic membranous nephropathy with nephrotic syndrome [J]. Pharmacology, 2013, 91(5-6): 259-266.
[20]
窦涪琳. 长疗程他克莫司治疗特发性膜性肾病的临床疗效观察及长期随访[D]. 吉林大学,2016.
[21]
Yap DY, Ma MK, Mok MM, et al. Long-term data on tacrolimus treatment in lupus nephritis [J]. Rheumatology (Oxford), 2014, 53(12): 2232-2237.
[22]
Caro J, Gutiérrez-Solís E, Rojas-Rivera J, et al. Predictors of response and relapse in patients with idiopathic membranous nephropathy treated with tacrolimus [J]. Nephrol Dial Transplant, 2015, 30(3): 467-474.
[23]
Li X, Liu Z, Wang L, et al. Tacrolimus monotherapy after intravenous methylprednisolone in adults with minimal change nephrotic syndrome [J]. J Am Soc Nephrol, 2017, 28(4): 1286-1295.
[24]
Liang Q, Li H, Xie X, et al. The efficacy and safety of tacrolimus monotherapy in adult-onset nephrotic syndrome caused by idiopathic membranous nephropathy [J]. Ren Fail, 2017, 39(1): 512-518.
[25]
宋艳,成璐,贾淼鑫,等. 肾病综合征患者他克莫司血药浓度监测的回顾性分析与评价[J]. 中国医院药学杂志,2017, 37(7): 654-658.
[26]
Ren S, Wang Y, Xian L, et al. Comparative effective and tolerance of immunosuppressive treatments for idiopathic membranous nephropathy: A network meta-analysis [J]. PLoS One, 2017, 12(9): e0184398.
[27]
Zhang X, Ji L, Yang L, et al. The effect of calcineurin inhibitors in the induction and maintenance treatment of lupus nephritis: a systematic review and meta-analysis [J]. Int Urol Nephrol, 2016, 48(5): 731-743.
[28]
Qiu TT, Zhang C, Zhao HW, et al. Calcineurin inhibitors versus cyclophosphamide for idiopathic membranous nephropathy: A systematic review and meta-analysis of 21 clinical trials [J]. Autoimmun Rev, 2017, 16(2): 136-145.
[29]
Chen M, Li H, Li XY, et al. Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial [J]. Am J Med Sci, 2010, 339(3): 233-238.
[30]
Butani L, Ramsamooj R. Experience with tacrolimus in children with steroid-resistant nephrotic syndrome [J]. Pediatr Nephrol, 2009, 24(8): 1517-1523.
[31]
Morgan C, Sis B, Pinsk M, et al. Renal interstitial fibrosis in children treated with FK506 for nephrotic syndrome [J]. Nephrol Dial Transplant, 2011, 26(9): 2860-2865.
[32]
李喆. 肾病综合征他克莫司治疗后急性肾损伤的临床特征及预后[D]. 南京大学,2015.
[1] 杨皓媛, 龚杰, 邹青伟, 阮航. 哮喘孕妇的母婴不良妊娠结局研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 522-529.
[2] 张华, 孙宇, 乡世健, 李樱媚, 王小群. 循环肿瘤细胞预测晚期胃肠癌患者化疗药物敏感性的研究[J]. 中华普通外科学文献(电子版), 2023, 17(06): 422-425.
[3] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[4] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[5] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[6] 汪毅, 许思哲, 任章霞. 胸乳入路腔镜单侧甲状腺叶切除术与开放手术对分化型甲状腺癌患者术后恢复的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 542-545.
[7] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[8] 邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.
[9] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[10] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[11] 高显奎, 赵太云, 陆兴俊, 张洪领, 房修罗, 闫碧春, 王胤, 王永翠, 刘苗苗, 冉若男. 内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 452-455.
[12] 张景旭, 李德舫, 由上可, 张玉田. 贝伐珠单抗与安罗替尼联合奥沙利铂治疗晚期直肠癌的临床疗效[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 289-293.
[13] 杨镠, 秦岚群, 耿茜, 李栋庆, 戚春建, 蒋华. 可溶性免疫检查点对胃癌患者免疫治疗疗效和预后的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 305-311.
[14] 李莹倩, 李华山. 基于真实世界的完全性直肠脱垂治疗方式评价[J]. 中华临床医师杂志(电子版), 2023, 17(06): 700-705.
[15] 徐玲玲, 田汉, 闻萍, 何伟春. 利妥昔单抗治疗难治性微小病变性肾病一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(05): 617-621.
阅读次数
全文


摘要