目的 观察肾功能、三酰甘油、血清白蛋白、24 h尿蛋白、临床症状等多项指标，在采用他克莫司联合阿魏酸哌嗪及他克莫司单药治疗的老年原发性肾病综合征患者中的变化及其意义。方法 选取2017年1月至2017年10月我院收治的老年原发性肾病综合征患者50例，按就诊顺序将入选对象分为联合治疗组（25例）和他克莫司单药治疗组（25例），平均疗程为6个月[（5.6±0.8）个月]，比较治疗前后2组患者肾功能、三酰甘油、血清白蛋白、24 h尿蛋白、临床症状等指标变化，并观察其临床疗效及不良反应发生情况。结果 联合治疗组与单药治疗后的24 h尿蛋白[（2.5±0.9） g比(3.6±1.0） g]、血浆白蛋白[（39.9±1.9） g/L比(34.6±2.1） g/L]、血浆蛋白原[（4.2±1.1） g/L比(7.2±0.9） g/L]、血D-二聚体[（0.88±0.23） mg/L比(1.36±0.35） mg/L]均比单药治疗组有所改善，差异有统计学意义（P均<0.05）;联合治疗组治疗后的临床总有效率优于单药治疗组（84%比72%）(P<0.05）。联合治疗组的不良反应发生率与单药治疗组相比，差异无统计学意义（12%比8%，P>0.05）。结论 采用他克莫司联合阿魏酸哌嗪治疗的老年原发性肾病综合征患者，其各项临床指标改善情况及疗效均优于他克莫司单药治疗组，且药物不良反应发生率未增加。

Objective: To observe the change of clinical indicesontreatment with tacrolimus combined with piperazine ferulate in elderly patients with primary nephrotic syndrome. Methods: Fifty elderly patients with primary nephrotic syndrome were randomly divided into combined therapy group (25 case) and the single therapy group (25 case) to be treated with tacrolimus combined with piperazine ferulate or single tacrolimus for 6 months, respectively. The changes of indices includedserum triglyceride, cholesterol, albumin, creatinine, urea nitrogen, urine protein andtherapeutic efficacy; the two groups were compared. Theadverse reactions were also compared. Results: The overall therapeutic efficacy of combined therapy group and single therapy group were 84% and 72%, respectively (P<0.05). The combined therapy group showed better improvement in serum albumin [(39.9±1.9) g/L vs (34.6±2.1) g/L] and urine protein [(2.5±0.9) g vs (3.6±1.0） g](P<0.05). Adverse reactions showed no significant difference between the combined therapy group and single therapy group（12% vs 8%, P>0.05）. Conclusions: Tacrolimus combined with piperazine ferulate is better than tacrolimus only for the treatment of primary nephrotic syndrome in elderly patients without increase inadverse reactions.