目的 探讨小剂量泼尼松联合他克莫司治疗难治性肾病综合征的临床疗效。方法 选择2016年1月—2018年1月海南医学院第二附属医院收治的难治性肾病综合征患者80例，采用随机数字表法分为观察组与对照组，每组各40例。对照组口服他克莫司胶囊，50 μg/（kg·d），2次/d。观察组在对照组的基础上口服醋酸泼尼松片，0.75 mg/（kg·d），治疗8周后每周逐渐减少10%的剂量，两组均治疗6个月。比较两组患者的临床疗效，同时比较两组患者治疗前后的肾功能指标、炎症因子水平、血小板计数、尿蛋白、抗ds-DNA、补体C3和补体C4水平。结果 治疗后，观察组的治疗有效率95.0%明显高于对照组的85.0%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组24 h尿蛋白定量（24 hUPQ）、血肌酐（Scr）、胱抑素C（CysC）、尿素氮（BUN）水平均显著降低（P<0.05）；观察组治疗后的24 h UPQ、Scr、CysC、BUN水平明显低于对照组（P<0.05）。治疗后，两组肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平均显著降低（P<0.05）；观察组治疗后的TNF-α、IL-2、IL-6、IL-8水平明显低于对照组（P<0.05）。治疗后，两组患者的血小板计数、尿蛋白、抗ds-DNA、补体C3和C4显著优于治疗前（P<0.05）；且治疗后，观察组患者的血小板计数、补体C3、C4水平显著高于对照组，尿蛋白、抗ds-DNA水平显著低于对照组（P<0.05）。结论 小剂量泼尼松联合他克莫司治疗可有效改善难治性肾病综合征患者的肾功能，抑制炎症反应，治疗效果良好，值得推荐。

Objective To investigate the clinical efficacy of low dose prednisone combined with tacrolimus in treatment of refractory nephrotic syndrome. Methods A total of 80 patients with refractory nephrotic syndrome admitted to Second Affiliated Hospital of Hainan Medical College from January 2016 to January 2018 were randomly divided into observation group and control group, each groups had 40 cases. The control group were po administered with Tacrolimus Capsules, 50 μg/(kg·d), twice daily. And the observation group were po administered with Prednisone Acetate Tablets on the basis of control group, 0.75 mg/(kg·d), and gradually reduced the dose by 10% per week after 8 weeks of treatment. Both groups were treated for 6 months. The clinical efficacy of the two groups was compared, and the renal function indicators, inflammatory factor levels, platelet count, urine protein, anti dsDNA, complement C3 and complement C4 levels in two groups before and after treatment were also compared. Results After treatment, the effective rate in the observation group was 95.0%, which was significantly higher than 85.0% in the control group, and the difference between two groups was statistically significant (P<0.05). After treatment, 24 hUPQ, Scr, CysC, and BUN levels in two group were significantly decreased (P<0.05). After treatment, 24 hUPQ, Scr, CysC, and BUN levels in the observation group were significantly lower than those in the control group (P<0.05). After treatment, TNF-α, IL-2, IL-6 and IL-8 levels in two group were significantly decreased (P<0.05). After treatment, the levels of TNF-α, IL-2, IL-6 and IL-8 in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the platelet count, urine protein, anti ds-DNA, complement C3 and C4 in two groups were significantly better than those before treatment (P<0.05). After treatment, the levels of platelet count, complement C3 and C4 in the observation group were significantly higher than those in the control group, and the levels of urine protein and anti ds-DNA were significantly lower than those in the control group (P<0.05). Conclusion Low dose prednisone combined with tacrolimus can effectively improve the renal function of patients with refractory nephrotic syndrome, inhibit the inflammatory response, the treatment effect is good, it is worth recommending.

R983

海南省自然科学基金资助项目（814342）