雷公藤多苷、来氟米特及小剂量激素治疗特发性膜性肾病的临床研究

Treatment of Idiopathic Membranous Nephropathy with Tripterygium Wilfordii,Leflunomide and Steroid:A Prospective Clinical Study

目的观察雷公藤多苷、来氟米特联合小剂量激素治疗特发性膜性肾病(IMN)的临床疗效和安全性。方法我院2006年9月～2010年8月经肾活检并结合临床诊断为IMN患者24例,尿蛋白>3.5g/24h。雷公藤多苷(TW)60mg/d、来氟米特(LEF)20mg/d口服6个月后剂量减半,持续至12个月,泼尼松(P)30mg/d,8周后逐渐减量(每2周减5mg),10mg/d维持至12个月。结果共24例患者。治疗3个月,2例(8.3%)完全缓解,9例(37.5%)部分缓解,有效率为45.8%。治疗6个月,3例(12.5%)完全缓解,15例(62.5%)部分缓解,有效率为75.0%。治疗12个月,8例(33.3%)完全缓解,11例(45.8%)部分缓解,有效率为79.1%。起病年龄轻和血脂甘油三酯较低者对治疗反应较好,治疗过程中血清肌酐亦有所下降,不良反应发生率低。结论雷公藤多苷、来氟米特联合小剂量激素治疗能有效减少膜性肾病患者蛋白尿,患者耐受性好,不良反应少,是治疗IMN的安全有效方法。

Objective To evaluate the therapeutic efficacy of tripterygium wilfordii （ TW ）, leflunomide （ LEF ） combined steroid in patients with idiopathic membranous nephrnpathy （ IMN ）. Methods Twenty-four cases of biopsy-proven IMN were enrolled in this trial, with proteinuria 〉 3.5 g/24h. They were given three drugs in combination, TW 60 mg/d and LEF 20 mg/d for 6 months, then tapered to maintenance doses of TW 30 mg/d and LEF 10 mg/d for 12 months, and prednisone 30 mg/d for 8 weeks with taper doses of 10 mg/d for 12 months. Results After 3, 6 and 12 months treatment, the complete remission rates were 8.3%, 12.5% and 33.3%; The partial remission rates were 37.5%, 62.5% and 45.8%. Younger onset and lower blood triglyceride in patients, the treatment effect is better. Serum creatinine was also decreased during treatment. No severe adverse events were observed during the course of treatment. Conclusion A 12-month course of treatment reveales that TW, LEF combined with low dose steroid is a useful therapy to reduce proteinuria in patients with IMN. It＇ s a promising therapeutic option for patients with IMN.