来氟米特治疗过敏性紫癜肾炎的临床观察

Clinical observation of the effect of leflunomide on purpuric nephritis nephrotic syndrome

目的观察新型免疫抑制剂来氟米特治疗过敏性紫癜肾炎的疗效及安全性。方法经过肾活检确诊为过敏性紫癜肾炎、达到肾病综合征程度的住院患者90例,随机分配来氟米特实验组、环磷酰胺对照组及单纯皮质醇激素对照组,每组均为30例患者,总共治疗时间6个月至1年,停药后随访2年。观察治疗前后尿红细胞计数、24 h尿蛋白定量、血常规、肝功能、肾功能、皮肤紫癜以及肾炎复发次数及药物不良反应,按照疗效评定标准对比分析来氟米特实验组与对照组的疗效及安全性。结果三组患者治疗结束时尿蛋白定量与尿红细胞数均有明显减少(P<0.01),来氟米特组尿蛋白与尿红细胞数又明显少于两对照组(P<0.05),环磷酰胺对照组尿蛋白明显少于单纯皮质醇激素对照组(P<0.05)。随访期间来氟米特组复发率为6.7%,环磷酰胺对照组复发率为16.7%,单纯皮质醇激素对照组复发率为33.3%。来氟米特组明显低于环磷酰胺组(P<0.01),环磷酰胺组又低于单纯皮质醇激素对照组(P<0.01)。结论来氟米特联合皮质醇激素对过敏性紫癜肾炎的血尿和蛋白尿均有良好的疗效,并且复发率低,副作用少。

【Objective】 To observe the curative effect and safety of Leflunomide-a new type immunosupressor on purpuric nephritis nephrotic syndrome.【Methods】 90 purpuric nephritis nephrotic syndrome inpatients were included whose diagnosis were confirmed by renal biopsy.They were randomly divided into 3 groups,leflunomide treatment group,CTX treatment control group and corticosteroids treatment control group,30 patients in each group.The total treatment length ranged from 6 months to 1 year,and 2 years follow-up after cease treatment.Urine RBC counting,quantity of urine protein /day,Blood routine test,hepatic and renal function examination before and after treatment were detected and relapse time of skin purpura or nephritis and side effect of drugs were observed.Comparative analysis of the curative effect and safety of leflunomide experiment group and control groups were made according to the curative effect evaluating standards.【Results】 After treatment,urine RBC counting and quantity of urine protein in each group were heavily decreased（P 〈0.01）.Decrease of urine RBC counting and quantity of urine protein in leflunomide group were greater than the other two groups（P 〈0.01）.Decrease of urine RBC counting and quantity of urine protein in CTX group were greater than corticosteroid groups（P 〈0.05.During the follow-up period,the relapse rate in leflunomide group was 6.7%,which in CTX group was 16.7% and a corticosteroid group was 33.3%.The relapse rate in leflunomide group was much lower than that in the CTX group（P 〈0.01）.The relapse rate in CTX group was much lower than that in the corticosteroid group（P 〈0.01）.【Conclusion】 Combined use of leflunomide with corticosteroid demonstrated superior effect to the hematuria and proteinuria in purpuritic nephritis nephrotic syndrome,with low rate of relapse and few side effect.