来氟米特和环磷酰胺治疗IgA肾病（Haas分型Ⅲ～Ⅳ型）的对照研究

Comparison of effect of leflunomide and cydophosphamide on IgA nephropathy（Haas stage Ⅲ～Ⅳ）

目的比较来氟米特和环磷酰胺分别联合小剂量糖皮质激素治疗IrA肾病（Haas分型Ⅲ～Ⅳ型）的疗效和安全性。方法将90例IrA肾病（Haas分型Ⅲ～Ⅳ型）且激素治疗无效的患者分为来氟米特联合激素及环磷酰胺联合激素组，随访1年，治疗期间每月检测血常规、尿常规、24h尿蛋白定量及肝肾功能等。结果来氟米特组治疗缓解率（75．6％）与环磷酰胺组相当（73．3％，P〉0．05），但来氟米特组不良反应发生率（15．6％）低于环磷酰胺组（35．6％，P〈0．05）。结论来氟米特联合小剂量激素对激素治疗无效的IrA肾病（Haas分型Ⅲ～Ⅳ型）效果明显，且不良反应发生率低。

Objective To compare the efficacy and safety of leflunomide and cyclophosphamide combined with glucocorticoid respectively in treatment of IgA nephropathy（Haas stage Ⅲ～Ⅳ）. Methods Ninty patients with biopsy- confirmed IgA nephropathy （Haas stage Ⅲ～Ⅳ） who did not respond to glucocorticoid were randomly divided into two groups. The observation group was given leflunomide combined with glucocorticoid, and the control group was given cyclophospharnide combined with glucocorticoid. Blood routine, routine urine, 24h urinary protein, serum albumin and serum creatinine were detected monthly, and then the efficacy and adverse reactions after 1 year were analyzed. Rusnlts At the end of the follow-up, total effective rate of leflunomide group was 75.6%, and cyclophosphamide group was 73.3%, without significant difference between the two groups（P〉0.05）. The incidence of adverse reactions in the leflu- nomide group was 17.8%, while the cyclophosphamide group was 31.1%, with significant differentce （P〈0.05）. Conclusion Leflunomide combined with glucocorticoid has significant effect on IgA nephropathy（Haas stage Ⅲ～Ⅳ） patients, to whom glucocorticoid were ineffective, with fewer dosage of glucocorticoid; it has similar effect of cyclophosphamide combined with glucocorticoid and it has lower incidence of adverse reaction.