来氟米特治疗对环磷酰胺无效或无法耐受的狼疮性肾炎的临床观察

An observational study of leflunomide in the treatment of lupus nephyritis for cyclophosphamide was invalid or could not be tolerated

目的:观察来氟米特治疗对环磷酰胺治疗无效或无法耐受的狼疮性肾炎(LN)的疗效和安全性。方法:23例经环磷酰胺治疗无效或无法耐受且均经肾穿刺活检证实的LN患者,停用环磷酰胺4周后,应用来氟米特及强的松治疗,疗程6个月;治疗期间监测有关指标并记录所有不良反应;治疗前后行疗效、狼疮活动指数(SLEDAI)及安全性评价。结果:共有22例完成治疗、1例因费用问题退出治疗。治疗2个月后开始起效、3～4个月后明显有效、6个月时各项指标仍较稳定。治疗前后SLEDAI评分明显改善,总有效率为77%。来氟米特不良反应轻,以胃肠道症状、带状疱疹、脱发多见。结论:来氟米特联合强的松用于环磷酰胺治疗无效或无法耐受的LN有较好的效果,耐受性尚好。

Objective：To investigate the efficacy and reliability of leflunomide as a drug in the treatment of Lupus nephritis for cyclophosphamide is invailid or can not be tolerated.Methods：A total of 23 cases were observed in lupus nephritis patients determined by kidney biopsy.Before being grouped ,patients had received regular cyclophosphamide treatment because cyclophosphamide was invalid or could not be tolerated and disabled for 4 weeks.All patients at the same in the application of leflunomide combined with prednisone were observed for 6 months.During treatment a 24-hour urinary,blood routine,plasma albumin,liver and kidney function,anti-dsDNA antibody titers,complement C3,erythrocyte sedimentation rate were monitored and all side effects were recorded.Before and after treatment,We evaluated the efficacy and reliability of leflunomide and lupus activity index.Results：A total of 22 patients completed the trial,only 1 patient was out of treatment due to the cost.The patients of lupus nephritis had some responses at the second month visit and have obvious responses at the third or four month visit after therapy.The improvements were maintained at the six month.Before and after treatment ,We discovered that SLEDAI scores of all patients were significantly improved（the total effective rate was 77%.）.With gastrointestinal tract symptoms,shingles,hair loss more common,the side effects of leflunomide were few and mild.Conclusions：Leflunomide combined with prednisone for cyclophosphamide was invalid or could not be tolerated in lupus nephritis had good efficacy,tolerance could be.