内科

目的探讨泼尼松联合他克莫司、吗替麦考酚酯治疗增殖性狼疮性肾炎（LN）的临床效果。方法选取2013年1月至2017年12月在我院治疗的增殖性LN患者60例为研究对象，采用随机数字表法分为观察组与对照组，每组30例。两组患者均先用甲基泼尼龙进行冲击治疗，随后口服泼尼松治疗。在此基础上，对照组患者给予环磷酰胺（CTX）治疗，观察组患者给予吗替麦考酚酯分散片联合他克莫司（FK506）治疗。两组患者均连续治疗6个月，比较两组患者的系统性红斑狼疮疾病活动性指数（SLEDAI2000）评分，血清肌酐（SCr）、24 h尿蛋白、血清补体C3（C3）以及血清白蛋白（Alb）水平；比较两组患者的临床疗效及不良反应发生情况。结果治疗6个月后，两组患者的SLEDAI2000评分、SCr水平和24 h尿蛋白水平均明显降低，C3、Alb水平明显升高；观察组患者上述指标均显著优于对照组，差异有统计学意义（P＜0.05）；观察组患者的治疗总有效率（90.0%）明显高于对照组（66.7%），差异有统计学意义（P＜0.05）。治疗过程中，观察组患者的不良反应发生率（33.33%）显著低于对照组（73.33%），差异有统计学意义（P＜0.05）。结论泼尼松联合他克莫司、吗替麦考酚酯治疗增殖性LN患者，可有效改善患者的肾功能，临床疗效良好，不良反应发生率低，具有较高的临床应用价值。

ObjectiveTo investigate the clinical effects of prednisone combined with tacrolimus and mycophenolate mofetil in the treatment of proliferative lupus nephritis (LN). MethodsA total of 60 patients with proliferative LN who were treated in our hospital from January 2013 to December 2017 were selected and divided into observation group and control group by random number table, with 30 cases in each group. The patients in the two groups were treated with methylprednisolone and prednisone. On this basis, patients in the control group were treated with cyclophosphamide (CTX), and patients in the observation group were given mycophenolate dispersible tablets combined with tacrolimus (FK506). The patients in the two groups were treated for 6 months and the systemic lupus erythematosus disease activity index（SLEDAI2000）score, serum creatinine (SCr), 24 h urine protein, complement C3 (C3) , serum albumin (Alb) levels, clinical efficacy and the adverse reactions between the two groups were compared. ResultsAfter 6 months of treatment, the SLEDAI2000 score, SCr level and 24 h urinary protein level were significantly decreased in the two groups, and the levels of C3 and Alb were significantly increased. The above indexes in the observation group were significantly superior than that in the control group, the difference was statistically significant(P＜0.05).The total effective rate of treatment in the observation group (90.0%) was higher than that in the control group (66.7%), the difference was statistically significant (P＜0.05). During the treatment, the incidence of adverse reactions in the observation group (33.33%) was significantly lower than that in the control group (73.33%), the difference was statistically significant (P＜0.05). ConclusionPrednisone combined with tacrolimus and mycophenolate mofetil in the treatment of patients with proliferative LN can effectively improve kidney function in patients, it has a good clinical efficacy and can reduce the incidence of adverse reactions, which has a high clinical application value.