2024 年第 4 期 第 19 卷

硫酸羟氯喹联合糖皮质激素治疗特发性膜性肾病效果及安全性研究

Efficacy and safety of hydroxychloroquine sulfate combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

作者：李娜蓝晓红王玥坤高宏玉

英文作者：Li Na Lan Xiaohong Wang Yuekun Gao Hongyu

单位：东部战区总医院药剂科，南京210018

英文单位：Department of Pharmacy General Hospital of Eastern Theater Command Nanjing 210018 China

关键词：特发性膜性肾病；硫酸羟氯喹；糖皮质激素；治疗效果；安全性

英文关键词：Idiopathicmembranousnephropathy;Hydroxychloroquinesulfate;Glucocorticoids;Therapeuticeffect;Safety

• 摘要：

• 目的 探讨硫酸羟氯喹联合糖皮质激素治疗特发性膜性肾病（IMN）的临床效果。方法 选取东部战区总医院2021年10月至2023年2月收治的83例IMN患者，采用随机数字表法将患者分为对照组（41例）和观察组（42例）。所有患者均接受肾素-血管紧张素系统抑制剂、利尿剂、抗凝药和钙调神经磷酸酶抑制剂环孢素的常规治疗。对照组在常规治疗基础上给予醋酸泼尼松片口服治疗；在对照组基础上，观察组给予硫酸羟氯喹口服治疗；2组患者均治疗12个月。比较2组临床治疗效果。检测并比较2组治疗前后总胆固醇、血肌酐、甘油三酯、白蛋白、C反应蛋白、低密度脂蛋白胆固醇、估算肾小球滤过率和24 h尿蛋白水平。比较2组不良反应发生情况。结果治疗后，观察组临床总有效率高于对照组［92.9%（39/42）比70.7%（29/41）］，差异有统计学意义（χ2=6.860，P=0.009）。治疗后,观察组总胆固醇、血肌酐、甘油三酯、C反应蛋白、24 h尿蛋白和低密度脂蛋白胆固醇水平低于对照组，差异均有统计学意义（均P＜0.05）；观察组白蛋白和估算肾小球滤过率水平高于对照组，差异均有统计学意义（均P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P=0.526）。结论 硫酸羟氯喹联合糖皮质激素治疗IMN临床效果较好，能够明显控制蛋白尿，改善肾功能，调节血脂，且安全性较好。

• Objective To investigate the clinical effect of hydroxychloroquine sulfate combined with glucocorticoid in the treatment of idiopathic membranous nephropathy (IMN). Methods A total of 83 IMN patients admitted to the General Hospital of Eastern Theater Command from October 2021 to February 2023 were selected. The patients were divided into control group (41 cases) and observation group (42 cases) by random number table method. All patients received conventional therapy with inhibitors of the renin-angiotensin system, diuretics, anticoagulants and the calcineurin inhibitor cyclosporine. The control group was given oral prednisone acetate tablets on the basis of conventional treatment. On the basis of the control group, the observation group was treated with hydroxychloroquine sulfate orally. Patients in both groups were treated for 12 months. The clinical effects of the two groups were compared. The levels of total cholesterol, serum creatinine, triglyceride, albumin, C-reactive protein, low-density lipoprotein cholesterol, the estimated glomerular filtration rate and 24 h urine protein were detected and compared between the two groups before and after treatment. The incidence of adverse reactions was compared between the two groups. Results After treatment, the total effective rate of the observation group was higher than that of the control group ［92.9%（39/42） vs 70.7%（29/41）］(χ2=6.860, P=0.009). After treatment, the levels of total cholesterol, serum creatinine, triglyceride, C-reactive protein, 24 h urine protein and low-density lipoprotein cholesterol in the observation group were lower than those in the control group (all P＜0.05). The levels of albumin and the estimated glomerular filtration rate in the observation group were higher than those in the control group (both P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.526). Conclusion Hydroxychloroquine sulfate combined with glucocorticoid has good clinical effect in the treatment of IMN, which can significantly control proteinuria, improve renal function, regulate blood lipids, and has good safety.