来氟米特与雷公藤多苷及单纯激素治疗IgA肾病的疗效观察

Comparison Clinical Effect of Lefunomide Combined with Medium Dose Glucocorticoid and Triptolide with Medium Dose Glucocorticoid and Routine Dose Glucocorticoid for IgA Nephropathy of Medium Albuminuria

目的:了解来氟米特(LEF)、雷公藤多苷联合激素,以及单纯激素治疗IgA肾病的疗效。方法:回顾性分析不同方法治疗的中等量蛋白尿IgA肾病患者61例,其中来氟米特联合中等量激素(LEF组)21例,雷公藤多苷联合中等量激素(雷公藤多苷组)24例,单纯常规量激素治疗组16例。观察用药期间24h尿蛋白定量、血尿素氮、血肌酐、血常规、血胆固醇、血清白蛋白、肝功能的变化,同时记录不良反应。结果:治疗24周后,LEF组的完全缓解率及总有效率分别为31.6%和84.2%,雷公藤多苷组的完全缓解率及总有效率分别为46.7%和86.7%,单纯激素组的完全缓解率及总有效率分别为46.7%和73.3%,3组疗效差异无统计学意义。治疗期间单纯激素组的复发率为20%,其他两组均为0,单纯激素治疗组复发率与LEF组、雷公藤多苷组相比差异有统计学意义。LEF组、雷公藤多苷组、单纯激素组的不良反应发生率分别为14.2%、37.5%、12.5%,雷公藤多苷组不良反应的发生率较其他两组显著高,差异有统计学意义。结论:LEF、雷公藤多苷联合激素和单纯激素治疗IgA肾病的近期疗效相似,但单纯激素治疗复发率高,雷公藤多苷治疗不良反应发生率高。3种治疗方法的长期疗效和安全性有待于进一步观察。

Objective：To Compare the clinical effects of Lefunomide combined with medium dose glucocorticoid, triptolide with medium dose glucocorticoid, and routine dose glucocorticoid for IgA nephropathy with medium albuminuria. Methods： Sixtyone patients with IgA nephropathy with medium albuminuria were respectively treated with Lefunomide combined with medium dose glucocorticoid, triptolide with medium dose glucocorticoid, and routine dose glucocorticoid. The clinical data were collected and evaluated before and in weeks 2,4,12 and 24 during the treatment. Results： The 24 h urinary protein excretion was decreased significantly in three sets after 24 weeks. The complete remission rate and total effective rate in LEF group was 31.6% ,84.2%, in triptolide group was 46.7 % ,86.7 %, in glucocorticoid group was 46.7 % ,73.3 %. There was no significant difference among the three sets. Recurrence rate in glucocorticoid group was 20 %, and those in other sets were 0. There was significant difference between LEF group and glucocorticoid group, and alto between triptolide group and glucocorticoid group. Adverse effect rate in three sets respectively were 14.2 % ,37.5 %, 12.5 %, and there was significant aiffierence among LEF group and triptolide group, glucocorticoid group. Conclusion： Lefunomide combined with medium dose glucocorticoid and triptolide with medium dose glucocorticoid are also superior to routine dose glucocorticoid in the treatment of IgA nephropathy with medium albuminuria. Adverse effect rate in LEF group is lower than it in triptolide group.