来氟米特联合糖皮质激素治疗IgA肾病疗效观察

Effect of leflunomide plus glucocorticoids on IgA nephropathy

目的观察来氟米特联合糖皮质激素治疗IgA肾病的疗效和安全性。方法 IgA肾病患者60例,随机分为治疗组和对照组各30例,治疗组给予醋酸泼尼松联合来氟米特片口服;对照组仅给予醋酸泼尼松片口服,用法、用量同治疗组;2组疗程均为12个月。分别于治疗前及治疗后1、3、6、12个月测定2组24h尿蛋白定量、血浆白蛋白、血清肌酐、收缩压、舒张压水平,并比较2组疗效和不良反应发生情况。结果治疗后12个月,治疗组总有效率(93.3%)高于对照组(70.0%)(P<0.05),2组完全缓解率、不良反应发生率比较差异无统计学意义(P>0.05);治疗前及治疗后各时间点,2组血清肌酐、收缩压及舒张压比较差异无统计学意义(P>0.05);治疗组治疗后3、6、12个月,对照组治疗后6、12个月24h尿蛋白定量与白蛋白水平与治疗前比较差异有统计学意义(P<0.05);治疗后12个月,治疗组24h尿蛋白定量水平低于对照组,白蛋白水平高于对照组(P<0.05)。结论来氟米特联合糖皮质激素在减少IgA肾病尿蛋白,升高血浆白蛋白水平上优于单用糖皮质激素。

Objective To explore the therapeutic effect and safety of leflunomide plus glucocorticoid in the treatment of IgA nephropathy. Methods Sixty patients with IgA nephropathy were randomly divided into two groups： treatment group and control group, with 30 patients in each group. Treatment group was given oral administration of leflunomide plus prednisone, and control group was given only prednisone orally with the same dose as tratment group, totally for 12 months. The levels of 24-hour urine protein, plasma albumin, serum creatinine, systolic blood pressure and diastolic blood pressure were detected before treatment and 1, 3, 6 and 12 months after treatment. The therapeutic effect and adverse reactions were compared between two groups. Results After 12 months of treatment, the total effective rate was 93.3% in treatment group, higher than that in control group （70. 0%） （P〈C0.05）, and there were no significant differences in complete remission rate and incidence of adverse reactions between two groups. Serum creatinine level, systolic blood pressure and diastolic blood pressure showed no significant differences in both two groups after treatment in comparison with before treatment （P〉0. 05）. There were significant differences in 24 hour urine protein and plasma albumin levels in 3, 6 and 12 months after treatment in treatment group and in 6 and 12 months after treatment in control group in comparison with before treatment （P〈0.05）. In 12 months after treatment, 24-hour urine protein level was lower and plasma albumin level was higher in treatment group than that in control group （P〈0.05）. Conclusions Leflunomide plus glucocorticoid is more effective for reducing urine protein and increasing albumin than glucocorticoid in the treatment of IgA nephropathy.