Objective To evaluate clinical effects of tacrolimus combined with Jiaweihuangqichifeng decoction on treatment of old patients with idiopathic membranous nephropathy ( IMN ) . Methods 57 old patients with IMN who received treatment in outpatient or ward of Zhengzhou Jiaotong Hospital from June 2011 to June 2014 were selected. They were divided into control group(n=20)and observation group(n=37)according to treatment plan. Patients in control group were treated with tacrolimus combined with methylprednisolone orally, while patients in observation group took oral tacrolimus combined with Jiaweihuangqichifeng decoction. 24 h urine protein quantitation, serum albumin, red blood cell in urinary sediment, blood glucose and lipids levels,hepatic and renal function parameters of patients in two groups before treatment and after treatment of 8 weeks,12 weeks and 24 weeks were detected respectively;and clinical effects of 24 -week treatment and adverse reactions during treatment were recorded. Results 24 h urinary protein quantitation and red blood cell in urinary sediment of patients in two groups were significantly different ( P ﹤0. 05 );the comparison of different time points was significantly different ( P ﹤0. 05);therapeutic method and time had interactive effects on 24 h urinary protein quantitation and red blood cell in urinary sediment(P﹤0. 05). The serum albumin of patients in two groups was not significantly different(P﹥0. 05);the comparison of different time points was significantly different ( P ﹤0. 05 );therapeutic method and time had interactive effects on serum albumin( P﹤0. 05 ) . Fasting plasma glucose ( FPG ), total cholesterol ( TC ), low density lipoprotein ( LDL ) and high density lipoprotein(HDL)of patients in two groups were significantly different(P﹤0. 05);the comparison of different time points was significantly different(P﹤0. 05);therapeutic method and time had interactive effects on FPG,TC,LDL and HDL ( P﹤0. 05 ) . Serum creatinine ( SCr ) and ALT of patients in two groups were not significantly different ( P ﹥0. 05 );the comparison of different time points was significantly different(P﹤0. 05);therapeutic method and time had no interactive effects on SCr and ALT(P ﹥0. 05). The comparison of uric acid(UA)of patients in two groups was significantly different(P ﹤0. 05);the comparison of different time points was significantly different(P ﹤0. 05);therapeutic method and time had no interactive effects on UA(P﹥0. 05). Estimate glomerular filtration rate(eGFR)and gamma glutamyl transpeptidase(GGT) of patients in two groups were not significantly different ( P﹥0. 05 );the comparison of different time points was significantly different(P﹤0. 05);therapeutic method and time had no interactive effects on eGFR and GGT(P ﹥0. 05). The clinical effects of patients in two groups were not significantly different ( P ﹥0. 05 ) . The incidence of adverse reactions of patients in observation group was significantly lower than that in control group ( P ﹤0. 05 ) . Conclusion Tacrolimus combined with Jiaweihuangqichifeng decoction and tacrolimus combined with hormone have similar curative effects on treatment of old patients with IMN. With good patient tolerance, it is suitable for clinical treatment of IMN old patients with glucocorticoid contraindication.%目的：探讨他克莫司联合加味黄芪赤风汤治疗老年特发性膜性肾病（ IMN）的临床疗效。方法选取2011年6月—2014年6月就诊于郑州交通医院门诊或病房的老年IMN患者57例，根据治疗方案分为对照组（ n＝20）和观察组（n＝37）。对照组患者口服他克莫司联合甲波尼龙，观察组患者口服他克莫司联合加味黄芪赤风汤。分别于治疗前及治疗8、12、24周后检测两组患者的24 h尿蛋白定量、血清蛋白、尿沉渣红细胞、血糖和血脂指标、肝肾功能指标，并记录两组治疗24周的临床疗效及治疗期间的不良反应发生情况。结果两组患者24 h尿蛋白定量、尿沉渣红细胞比较，差异有统计学意义（ P﹤0.05）；不同时间点比较，差异有统计学意义（ P﹤0.05）；治疗方法与时间在24 h尿蛋白定量、尿沉渣红细胞上存在交互作用（ P ﹤0.05）。两组患者血清蛋白比较，差异无统计学意义（ P ﹥0.05）；不同时间点比较，差异有统计学意义（P﹤0.05）；治疗方法与时间在血清蛋白上存在交互作用（P﹤0.05）。两组患者空腹血糖（ FPG）、总胆固醇（ TC）、低密度脂蛋白（ LDL）、高密度脂蛋白（ HDL）比较，差异有统计学意义（P﹤0.05）；不同时间点比较，差异有统计学意义（P﹤0.05）；治疗方法与时间在FPG、TC、LDL、HDL上存在交互作用（P﹤0.05）。两组患者血肌酐（SCr）、ALT比较，差异无统计学意义（P﹥0.05）；不同时间点比较，差异有统计学意义（P﹤0.05）；治疗方法与时间在SCr、ALT上无交互作用（P﹥0.05）。两组患者尿酸（UA）比较，差异有统计学意义（P﹤0.05）；不同时间点比较，差异有统计学意义（P﹤0.05）；治疗方法与时间在UA上无交互作用（P﹥0.05）。两组患者肾小球滤过率估计值（eGFR）、谷氨酰转肽酶（GGT）比较，差异无统计学意义（P﹥0.05）；不同时间点比较，差异无统计学意义（P﹥0.05）；治疗方法与时间在eGFR、GGT上无交互作用（P﹥0.05）。两组患者临床疗效比较，差异无统计学意义（ P﹥0.05）。观察组患者不良反应发生率低于对照组，差异有统计学意义（ P﹤0.05）。结论他克莫司联合加味黄芪赤风汤治疗老年IMN与他克莫司联合激素治疗方案有近似疗效，且患者耐受性较好，更适合于有糖皮质激素禁忌证老年IMN患者的临床治疗。
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