来氟米特与环磷酰胺治疗重症儿童IgA肾病的疗效比较

Leflunomide Therapy Versus Cyclophosphamide Treatment in Patients with Severe Children IgA Nephropathy

目的比较来氟米特(LEF)与环磷酰胺(CTX)静滴治疗重症儿童IgA肾病的临床疗效。方法41例重症儿童IgA肾病患者分别采用激素联合LEF治疗(LEF组,n=21),或采用激素联合CTX静注治疗(CTX组n=20)。LEF剂量1mg/kg最大不超过40mg,连用3d后以0.5mg/kg,最大不超过20mg维持诱导疗程均≥6个月;CTX剂量为8～12mg/kg,每两周连用2d静脉滴注,总量≤150mg/kg。两组患者基础病情无差异,随访时间≥12个月,疗效指标包括临床缓解率、24h尿蛋白定量和血脂变化。观察两组的临床疗效和副作用。结果①临床缓解率:治疗12个月时,LEF组临床总有效率高于CTX组,分别为90.4%和60.0%(P<0.05);②LEF组24h尿蛋白明显低于CTX组(0.6±0.3和1.4±0.8,P<0.05);③LEF组血脂明显降低(P<0.05),而CTX组无变化;④LEF组副作用的发生率明显低于CTX组(9.5%和40%,P<0.05)。结论激素联合LEF治疗儿童重症IgA肾病,临床缓解率高于CTX静脉滴注疗法,能更有效降低蛋白尿,改善血脂水平,且副作用发生率低于CTX疗法。

Objective To compare the clinical efficacy leflunomide（LEF） of with that of cyclophosphamide（CTX） in the treatment of severe IgA nephropathy. Methods Forty one patient s with severe IgA nephropathy were enrolled into this study and were divided into LEF and CTX groups.LEF group included 21 cases that were treated with LEF at a dosage of lmg/kg（≤40mg） for 3 days,then 0.5mg/kg（≤20mg） for 6 months. CTX group enrolled 20 cases that were givenintravenous drip 8-12mg/kg 2d per 2 weeks,and the total dosage was less than 150mg/kg. The patient s were followed up for more than 12 months. The clinical efficacy andside effect s were compared between the two groups. Results ①Clinical remission rate in the 12th month was 90.4%in LEF therapy and it was 60.0% in CTX group. The difference of the clinical remission rate between the two groups was significant（P〈 0.05）. ②The concentration of proteinuria in 24 h in LEF group was lower than that in CTX group（P〈0.05）. ③After the therapy, the level of blood 2 lipid decreasedobviously in LEF group, but it did not changed in CTX group（P〈 0.05）. ④The side effect in both groups were 9.5%（LEF group）vs 40%（CTX group）（P〈 0.05）. Conclusion The combination therapy of LEF and steroid was more effective than CTX intravenous drip in treatmentof severe IgA nephropathy and has fewer side effects.