来氟米特治疗狼疮性肾炎临床疗效及对肾功能和炎性因子影响

Effects of leflunomide on renal function and inflammatory factors in patients with lupus nephritis

目的观察免疫抑制剂来氟米特治疗狼疮性肾炎(LN)临床效果,并探讨其对患者肾功能、炎性介质表达的影响。方法选取郑州大学附属洛阳中心医院2018-07-02-2020-07-05收治的85例LN患者作为研究对象,按照组间性别、年龄、病程等因素具有可比性的原则分成2组。对照组42例给予环磷酰胺联合泼尼松治疗,观察组43例同时给予来氟米特治疗。对比观察3个月后2组患者临床疗效、肾功能、炎性介质、血清免疫学指标及血脂水平。结果观察组治疗后临床缓解率为90.70%(39/43),高于对照组的71.43%(30/42),差异有统计学意义,χ^(2)=5.163,P=0.023。2组治疗后尿β2-微球蛋白(β2-MG)、24 h尿蛋白定量、尿红细胞计数水平、系统性红斑狼疮疾病活动度评分(SLEDAI)分值均降低,但观察组降低幅度高于对照组,差异有统计学意义,均P<0.05;2组治疗后血清中C反应蛋白(CRP)、白细胞介素-17(IL-17)、白细胞介素-1β(IL-1β)水平均降低,但观察组降低幅度高于对照组,差异有统计学意义,均P<0.05;2组治疗后血清中补体C3、C4水平均升高,抗双链DNA(ds-DNA)、免疫球蛋白G(IgG)水平均降低,但观察组升高、降低幅度高于对照组,差异有统计学意义,均P<0.05;2组治疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均下降,高密度脂蛋白胆固醇(HDL-C)均上升,但观察组下降、上升幅度高于对照组,差异有统计学意义,均P<0.05。结论来氟米特能有效改善LN患者的肾功能、抑制炎性介质表达、调控血清免疫学指标及血脂水平,提高临床疗效,临床应用价值较高。

Objective To observe the application value of the immunosuppressant leflunomide in the treatment of patients with lupus nephritis(LN),and to explore the effect of leflunomide on the renal function and the expression of inflammatory mediators.Methods From July 2,2018 to July 5,2020,85 LN patients were divided into two groups according to random sampling method.In the control group,42 cases were given cyclophosphamide prednisone,whiile in observation group,43 cases at the same time were given leflunomide,we compared clinical curative effect,renal function,inflammatory mediators,serum immunological indexes,and blood lipid level of the two groups three months later.Results The clinical remission rate of the observation group was 90.70%(39/43)higher than that of the control group(71.43%,30/42),the difference was statistically significant(P<0.05).After treatment,urinaryβ2-microglobulin(β2-MG),24-hour urinary protein level,urinary erythrocyte count level and systemic lupus erythematosus disease activity score(SLEDAI)were all decreased in both groups,but the decrease range in observation group was higher than that in control group,the difference was statistically significant(P<0.05).Serum levels of C-reactive protein(CRP),interleukin-17(IL-17)and interleukin-1β(IL-1β)decreased in both groups after treatment,but the decrease range in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).After treatment,the levels of complement C3 and C4 in serum increased and the levels of anti double stranded DNA(ds-DNA)and immunoglobulin G(IgG)decreased in the two groups,but the ranges of increase and decrease in the observation group were significantly higher than those in the control group(P<0.05).After treatment,total cholesterol(TC),Triglycerides(TG)and low density lipoprotein cholesterin(LDL-C)levels in both groups decreased,while high-density lipoprotein cholesterol(HDL-C)levels increased,but the rangs of decrease and increase rate in the observation group were higher than those in the control group,the difference was statistically significant(P<0.05).Conclusion Leflunomide can effectively improve renal function in patients with LN,inhibit the expression of inflammatory mediators,regulate serum immunological indexes and blood lipid levels and improve clinical efficacy,thus have high clinical application value.