- 期刊
以Tacrolimus治療原發性腎絲球腎炎
Tacrolimus Therapy for Primary Glomerulonephritis
摘要
原發性腎絲球腎炎為一自體免疫疾病，也是造成慢性腎衰竭的最主要病因之一，在台灣是一重要的公共衛生和臨床問題。 原發性腎絲球腎炎的主要治療方式是使用免疫抑制藥物，第一線的選擇藥物以類固醇為主，第二線則是使用細胞毒性藥物或免疫調節劑。免疫調節劑目前證據較多的是環孢靈，在多數的病例都可以成功達到緩解，但是在一些頑固的腎絲球腎炎病例仍有可能治療失敗或是產生依賴性，這時候就要考應採用其他的免疫抑制劑來取代環孢靈。 Tacrolimus（Tac; FK506; Progaraf(上標 ®)普樂可復）的作用機轉和環孢靈相似，對T細胞有很好的選擇性。目前臨床上有許多病例報告和小型的臨床試驗，主要的病例是局部節段型腎絲球硬化和膜性腎病變等；有些病例是在類固醇治療失敗後的使用，也有環孢靈治療失敗後的病例。而相關報告的結果，顯示以tacrolimus治療原發性腎絲球腎炎是可行的。 移植用藥之研究，證實相較於環孢靈，tacrolimus有較低的毒性和副作用；因此它可作為原發性腎絲球腎炎患者使用環孢靈的替代性選擇。雖然因相關的臨床證據較少，但對於環孢靈治療效果不佳的病例，以tacrolimus替代選擇應是合理的。
並列摘要
Primary glomerulonephritis (GN) is an autoimmune disease which is not only one of the main causes of chronic renal failure, but also an important clinic and public health problem in Taiwan. Among immunosuppressive agents, corticosteroids is the first line of choice for management of primary GN, immunomodulators or cytotoxic agents is the second one. Cyclosporine A (CsA) is proved to achieve remission in most of GN cases, but some GN were failed to treat by CsA, or became CsA-dependent, so it is necessary to consider alternative agents. As CsA, tacrolimus (Prograf(superscript ®)) has a high selectiveness of T-cell and similar mechanisms. There had many case reports and some small-scale clinical trials showed that tacrolimus can replace CsA in cases of FSGS or MGN with failure to corticosteroids or CsA therapy. There is some evidences that tacrolimus is feasible to treat primary GN. Tacrolimus shows lower toxicity and less adverse effects than CsA in many studies of organ transplantation. Though the evidences are fewer, the replacement of CsA by tacrolimus should be a rational choice in primary GN patients who had poor response to CsA.