关键词: 肾小球肾炎, 膜性, 他克莫司, 黄芪赤风汤, 老年人, 治疗结果

Abstract: Objective　To evaluate clinical effects of tacrolimus combined with Jiaweihuangqichifeng decoction on treatment of old patients with idiopathic membranous nephropathy（IMN）.Methods　57 old patients with IMN who received treatment in outpatient or ward of Zhengzhou Jiaotong Hospital from June 2011 to June 2014 were selected.They were divided into control group（n=20） and observation group（n=37） according to treatment plan.Patients in control group were treated with tacrolimus combined with methylprednisolone orally,while patients in observation group took oral tacrolimus combined with Jiaweihuangqichifeng decoction.24 h urine protein quantitation,serum albumin,red blood cell in urinary sediment,blood glucose and lipids levels,hepatic and renal function parameters of patients in two groups before treatment and after treatment of 8 weeks,12 weeks and 24 weeks were detected respectively;and clinical effects of 24-week treatment and adverse reactions during treatment were recorded.Results　24 h urinary protein quantitation and red blood cell in urinary sediment of patients in two groups were significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on 24 h urinary protein quantitation and red blood cell in urinary sediment（P<0.05）.The serum albumin of patients in two groups was not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on serum albumin（P<0.05）.Fasting plasma glucose（FPG）,total cholesterol（TC）,low density lipoprotein（LDL） and high density lipoprotein（HDL） of patients in two groups were significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had interactive effects on FPG,TC,LDL and HDL（P<0.05）.Serum creatinine（SCr） and ALT of patients in two groups were not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on SCr and ALT（P>0.05）.The comparison of uric acid（UA） of patients in two groups was significantly different（P<0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on UA（P>0.05）.Estimate glomerular filtration rate（eGFR） and gamma glutamyl transpeptidase（GGT） of patients in two groups were not significantly different（P>0.05）;the comparison of different time points was significantly different（P<0.05）;therapeutic method and time had no interactive effects on eGFR and GGT（P>0.05）.The clinical effects of patients in two groups were not significantly different（P>0.05）.The incidence of adverse reactions of patients in observation group was significantly lower than that in control group（P<0.05）.Conclusion　Tacrolimus combined with Jiaweihuangqichifeng decoction and tacrolimus combined with hormone have similar curative effects on treatment of old patients with IMN.With good patient tolerance,it is suitable for clinical treatment of IMN old patients with glucocorticoid contraindication.

Key words: Glomerulonephritis,membranous, Tacrolimus, Huangqichifeng decoction, Aged, Treatment outcome