糖皮质激素联合环孢霉素和来氟米特对原发性膜性肾病的疗效

Effects of cyclosporine and leflunomide combined with low-dose prednisone in the treatment of idiopathic membranous nephropathy

目的通过对比观察小剂量糖皮质激素联合环孢霉素和来氟米特对原发性膜性肾病疗效。方法随机分为2组:试验组,激素+环孢霉素+来氟米特(醋酸强的松为0.5 mg·kg-1·d-1,环孢霉素为2～3 mg·kg-1·d-1,来氟米特为20 mg·d-1);对照组,醋酸强的松+环磷酰胺(醋酸强的松为0.5 mg·kg-1·d-1,环磷酰胺为12 mg·kg-1),每月1次;6次后,改为每3月1次;总量用至150 mg·kg-1。所有患者均予抗血小板及改善微循环治疗。随访时,观察血常规、尿常规、24 h尿蛋白定量、肝、肾功能。结果血清白蛋白上升水平及尿蛋白减少程度、缓解率,实验组优于对照组。结论小剂量糖皮质激素联合环孢霉素和来氟米特对原发性膜性肾病疗效优于传统的治疗方法,且安全有效。

Objective To compare the efficacy of cyclosporine and le-flunomide combined with low -dose prednisone vervus cyclophosphamide plus prednisone in the treatment of idiopathic membranous nephropathy.Methods A total of 28 patients were enrolled and were randomized into two groups （both, n = 14） ： trial group, were given low dose of predni-sone（0. 5 mg · kg^-1 · d^-1） combined with cyclosporine （2-3 mg · kg^-1 ·d^-1 ） and leflunomide （ 20 mg · d^ - 1 ） ; control group, received low dose of prednisone （0. 5 mg ·kg^ -1 · d^ -1 ） combined with cyclophos-phamide （ 12 mg · kg^-1 · m^-1 ）. After six times instead of once every March, amount to 150 mg · kg^-1. All patients were treated with anti-platelet drugs and microcirculation improving drugs. The serum albumin, 24 hours urine protein, liver and kidney function and better recovery were observed. Results The serum albumin rised, the 24 hours urine protein and better recovery in trial group was significantly better than in control group. Conclusion The cyclosporine and leflunomide combined with low - dose prednisone was effective and safety than the traditional therapy.