来氟米特、ACEI联合治疗IgAN的临床前瞻性对照研究

Clinical and Onward Comparison Research of Leflunomide and ACEI for Patients with IgA Nephropathy

目的探讨来氟米特、ACEI联合治疗IgAN的疗效和安全性。方法选择肾活检确诊为IgAN的病例40例,根据随机配对法,分设治疗组、对照组,每组各20例。观察来氟米特、ACEI联合疗法降低蛋白尿的临床疗效、副反应,并与激素联合ACEI疗法进行比较;观察来氟米特、ACEI联合疗法对肾功能的影响,并比较本疗法与激素联合ACEI疗法两组间肾功能的差异;治疗1年后重复肾活检,观察本疗法对改善病理病变的程度或阻止肾小球硬化及小管间质病变的疗效。结果治疗组和对照组均能降低蛋白尿、减少尿红细胞、升高血浆白蛋白及改善肾功能,两组治疗前后的差异具有统计学意义(P<0.05),同时治疗组较对照组在改善尿蛋白及升高血浆白蛋白疗效有显著性差异(P<0.05),尤其治疗组较对照组在改善远期肾功能方面的疗效有非常显著性差异(P<0.01)。两组治疗前后病理病变程度均有所减轻,差异有统计学意义(P<0.05)。治疗组较对照组治疗后病理病变的减轻程度的差异有统计学意义(P<0.05)。结论来氟米特、ACEI联合治疗IgAN能够降低蛋白尿和减少尿红细胞,抑制肾小球系膜增生、细胞外基质产生,同时能够防止肾小球硬化的发生或发展,能够改善IgAN的远期肾功能。

Objective To evaluate the efficacy and safety of leflunomide（LEF） combined with Angiotesin Converting Enzyme Inhibitor（ACEI） in the treatment of IgA nephropathy（IgAN）.Methods From January 2006 to December 2007,40 patients with biopsy-confirmed IgAN in our hospital were assigned randomly to two groups.20 patients in control group received LEF combined with ACEI（the LEF group）,and the other 20 patients in treatment group received prednisone combined with ACEI（the prednisone group）.24-hour urinary protein,renal function,serum albumin,urine erythrocyte were monitored.Efficacy and safety were evaluated after treatment.All patients would receive renal biopsy again after one year.Results After treatment,the proteinuria and urine erythrocyte in the two groups decreased significantly（P0.05）,serum albumin and renal function increased obviously（P0.05）,and pathological lesions in kidney relieved significantly（P0.05）.Compared with the prednisone group,the LEF group had less adverse and more efficacy in decreasing proteinuria,increasing serum albumin,relieving pathological lesions in kidney（P0.05）,and improving renal function（P0.01）.Conclusion In the treatment of IgAN,Leflunomide（LEF） combined with ACEI had exact effect in decreasing roteinuria,relieving urine erythrocyte,inhibiting the glomerular mesangial proliferation and extracellular matrix production,preventing glomerulosclerosis and improving renal function in the long time.Therefore,leflunomide（LEF） combined with ACEI was one of the safety and effective choices for treatment of IgAN.