来氟米特辅治免疫介导性肾脏病的疗效观察

Therapeutic effect of leflunomide on immune mediated nephropathy

目的观察来氟米特治疗免疫介导性肾脏病的疗效与安全性。方法免疫介导性肾脏病患者40例随机分为2组，每组20例，治疗组予激素联合来氟米特，对照组予激素联合环磷酰胺治疗，治疗0．5～1年后比较2组临床缓解率和不良反应发生率。结果治疗组总有效率高于对照组（90．0％vs 40．0％，P〈0．01）；治疗后2组患者血清白蛋白水平均不同程度上升（P〈0．05，P〈0．01），除对照组三酰甘油外，2组24h尿蛋白定量、血肌酐等指标水平均不同程度下降（P〈0．01），而治疗组较对照组改善更明显（P〈0．01）；不良反应发生率及严重程度均低于对照组（25．0％vs70．0％，P〈0．01）。结论来氟米特治疗免疫介导性肾脏病效果优于环磷酰胺，且安全性高。

Objective To observe the efficacy and safety of leflunomide in the treatment of immune mediated ne- phropathy, explore its application prospects. Methods 40 cases of immune mediated nephropathy were randomly divided into 2 groups, 20 cases received hormones combined with leflunomide treatment （treatment group）, 20 cases received hormone in combination with cyclophosphamide therapy as control group. After a course of treatment （about six months to 1 year ）, the clinical remission rate differences in the incidence and adverse reactions were compared between the two groups. Results Af- ter treatment, efficacy in the treatment group compared with the control group was significantly （90.0% vs. 40.0% , P 〈 0.01 ） ; the patientg serum albumin levels were increased with varying degrees （ P 〈 0.05, P 〈 0.01 ）, 24 hour urinary pro- tein, serum creatinine, blood triglycerides（ except control group） and other indicators were decreased of varying degrees （P 〈 0.01 ）, treatment group incidence of adverse reactions and severity were lower than the control group （ 25.0% vs. 70.0%, P 〈 0.01 ）. Conclusion Lefiunomide in the treatment of immune mediated nephropathy is more efficient than cyclophospha- mide, and adverse reactions lower than cyclophosphamide.