来氟米特联合缬沙坦治疗糖尿病肾病蛋白尿临床研究

Clinical study on leflunomide combined with valsartan in the treatment of diabetic nephropathy proteinuria

目的探讨来氟米特联合缬沙坦治疗糖尿病肾病蛋白尿的临床疗效。方法选取2013年7月至2015年7月在我院接受治疗的142例糖尿病肾病患者为研究对象,按就诊编号分为2组,单号纳入对照组,双号纳入研究组。对照组71例,采用缬沙坦治疗;研究组71例,在对照组基础上加用来氟米特治疗。2组均治疗3个疗程,疗程结束后,随访6个月。比较治疗前、后2组24h尿蛋白定量、血清白蛋白、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)及肝功能、肾功能相关指标的变化情况,并对2组临床疗效及安全性进行评价。结果与治疗前比较,2组24h尿蛋白定量、hs-CRP、IL-6水平在治疗后均降低,而血清白蛋白水平升高,且研究组上述观察指标均优于对照组,差异具有统计学意义(P<0.05)。治疗前、后2组丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿素氮、血肌酐水平相比均未见明显变化,且本组治疗前、后相比均未见明显变化,差异无统计学意义(P>0.05)。研究组临床疗效总有效率为95.77%(68/71),明显高于对照组的83.10%(59/71),差异具有统计学意义(P<0.05)。结论采用来氟米特联合缬沙坦治疗糖尿病肾病蛋白尿患者,可显著提高临床疗效、缓解临床症状、促进患者身体恢复,且对肝肾功能无明显影响,是一种安全有效的治疗方式,值得进一步推广应用。

Objective To investigate the clinical efficacy of leflunomide combined with valsartan in the treatment of diabetic nephropathy （DN） proteinuria. Methods 142 selected DN patients treated in the hospital from July 2013 to July 2015 were divided into two groups by registration order： odd numbers were included into control group and even numbers into research group. The patients in control group （n = 71 ） took valsartan, and those in research group（n = 71 ） were given leflunomide combined with valsartan. All the patients were treated with 3 courses and given 6-month follow-up after courses. The 24-h urinary protein quantity, serum albumin （AIB）, hypersensitive C-reactive protein （hs-CRP）, interleukin-6 （IL-6）, changes of related indexes of liver and renal function in the two groups before and after treatment were compared. The clinical efficacy and safety of two groups were evaluated. Results As compared with pre-treatment, the 24-h urinary protein quantity, hs-CRP, and IL-6 levels in the two groups were significantly decreased after treatmeflt, while AIB levels, and scores of physical health, mental health, physical activity, and social relations were significantly increased. The above-mentioned indexes in the research group were significantly better than those in the control group （P〈0. 05）. Before and after treatment, there were no obvious changes in alanine transaminase, aspartate aminotransferase, blood urea nitrogen and serum creatinine levels between the two groups, and there were no obvious changes in the group before and after treatment （P〉0. 05）. The total clinical effective rate in research group was 95. 77% （68/71）, significantly higher than 83. 10% （59/7]） of control group （P〈0. 05）. Conclusions Leflunomide combined with valsartan for treating proteinuria in DN patients can significantly increase clinical efficacy, relieve clinical symptoms, promote patients＇ recovery, improve survival quality and have no significant influence on liver and renal function, which is a kind of safe and effective treatment method and worthy of further generalization and application.