目的 探讨他克莫司和来氟米特治疗难治性肾病综合征的临床疗效。方法 选取2014年2月—2015年2月在郑州大学第一附属医院接受治疗的难治性肾病综合征患者76例，随机分为对照组（38例）和治疗组（38例）。对照组患者口服来氟米特片，50 mg/d，连续服用3 d后改为20 mg/d维持治疗；治疗组患者口服他克莫司胶囊，0.05 mg/(kg·d)，保持血药浓度在10 ng/mL。两组患者均连续治疗6个月。比较两组患者治疗前后临床疗效和观察指标。结果 治疗后，对照组和治疗组的总有效率分别为76.32%、94.74%，两组比较差异有统计学意义（P < 0.05）。治疗后，两组患者24 h尿蛋白定量（24 h Pro）、血肌酐（Scr）、血尿素氮（BUN）和三酰甘油水平均明显低于同组治疗前，血清白蛋白水平明显升高，同组比较差异具有统计学意义（P < 0.05）；且治疗组这些观察指标优于对照组，两组比较差异具有统计学意义（P < 0.05）。结论 他克莫司治疗难治性肾病综合征的临床效果好，有利于患者肾功能改善，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy between tacrolimus and leflunomide in treatment of refractory nephrotic syndrome. Methods Patients (76 cases) with refractory nephrotic syndrome in the First Affiliated Hospital of Zhengzhou University from February 2014 to February 2015 were divided into control (38 cases) and treatment (38 cases) groups. Patients in the control group were po administered with Leflunomide Tablets, 50 mg/time, and then 20 mg/time for maintenance treatment after treatment for 3 d. Patients in the treatment group were po administered with Tacrolimus Capsules, 0.05 mg/(kg·d), and kept blood concentration in 10 ng/mL. Patients in two groups were treated for six months. After treatment, the clinical efficacy, observation indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 76.32% and 94.74% respectively, and there was difference between two groups (P < 0.05). After treatment, the 24 h Pro, Scr, BUN, and TG levels in two groups significantly decreased, but the serum albumin significantly increased, and the difference was statistically significant in the same group (P < 0.05). And these indicators in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Tacrolimus has good clinical effect in treatment of refractory nephrotic syndrome, which is conducive to the improvement of renal function and has a certain clinical application value.