来氟米特治疗21例狼疮肾炎两次肾活检肾组织病变转化的分析

The analysis of renal lesions transformation of 21 lupus nephritis cases treated with leflunomide by repeated renal biopsies

目的评定来氟米特在治疗狼疮肾炎(LN)中的作用,分析两次肾活检肾脏病变类型的转化特点。方法经过来氟米特治疗LN并经过9～17个月后重复肾活检的21例LN,采用Katafuchi和Austin的评定标准,对肾小球、肾小管间质和血管病理变化和LN的活动性指数及慢性指数进行对比分析。结果①在第2次肾活检时,肾小球的节段性病变和肾小球的纤维素样坏死或“白金耳”改变与第1次有明显不同,但差异无统计学意义(P>0.05)。②LN的病变类型有转化,转化率43%,主要是Ⅳ型(70%)和Ⅴ型(40%)变化明显。③第2次肾活检有42%活动性指数下降,有53%(10/19)慢性指数有不同程度的升高。结论来氟米特首次用于治疗LN,并经重复肾活检证明病变类型有转化,由重转轻,活动性指数降低,可减缓疾病的进展,其作用机制有待于积累更多的重复肾活检病例验证。

Objective To evaluate the effect of leflunomide treatment for lupus nephritis (LN). To analyze pathologic type transformation through repeated renal biopsies. Methods Twenty-one cases of LN who had repeated renal biopsy were treated with leflunomide for 9～17 months. The pathologic changes of glomerulus, renal tubules, interregnal and blood vessel as well as active and chronic index of LN were compared and analyzed by standard of Katafuchi and Austin. Results ① There was obvious difference between the two renal biopsies on focal pathological changes and fibrinoid necrosis of glomerulus and 'platinum loop' pattern, but the difference was not significant (P>0.05). ② The pathologic type of LN had been transformed, its transformation rate was 43%. Type Ⅳ (70%) and type Ⅴ (40%) had very marked changes. ③ In the second renal biopsy, 42% had decreased activity index, 53% (10/19) chronic index had increased in various degree. Conclusions This is the firit time that leflunomide is the first used in the treatment of LN. It can cause pathologic type transformation and decreasing of activity index, it also abates disease progression. However, it′s mechanism of action needs to be provend by more repeated renal biopsies.