中等剂量糖皮质激素联合来氟米特治疗过敏性紫癜单纯镜下血尿的临床评价

Effect of moderate dose glucocorticoid combined with leflunomide on simple microscopic hematuria in henoch-schonlein purpura

目的:探讨中等剂量糖皮质激素联合来氟米特治疗过敏性紫癜单纯镜下血尿的有效性及安全性。方法:将过敏性紫癜(HSP)患者66例随机分为两组,观察组36例,对照组30例。观察组给予口服糖皮质激素0.5~0.6mg/kg,同时加服来氟米特片(美国欣凯)20mg,1/d;对照组给予糖皮质激素0.5~0.6mg/kg;两组糖皮质激素均口服4周后减量,每2周减量4~5mg,减至8~10mg,1/d维持治疗,疗程共6个月,随访时间6~12个月。治疗期间每4周复查血常规、尿常规、ALT、AST、血肌酐、血糖,对比分析两种治疗方式的安全性。以用药后3个月及6个月作为观察点,分别统计两组患者的尿红细胞计数情况,评价来氟米特的疗效。结果:66例患者61例完成疗程,余5例均未按要求随访。治疗后两组尿红细胞计数较同组治疗前均显著下降。用药3、6个月后,观察组红细胞计数较对照组下降明显,差异有统计学意义(P<0.05)。两组疗效比较观察组优于对照组,差异有统计学意义(P<0.05)。两组治疗结束后6~12个月复发率比较,观察组9.7%,治疗组13.3%,差异无统计学意义(P>0.05)。两组不良反应发生率基本持平,差异无统计学意义(P>0.05)。结论:中等剂量糖皮质激素联合来氟米特片治疗成人过敏性紫癜单纯镜下血尿疗效好、副作用低,可降低复发率。

Objective：To evaluate the efficacy and safety of medium dose glucocorticoid combined with leflunomide in the treatment of henoch-schonlein purpura（HSP）under simple microscopic hematuria.Methods：Sixty-six cases of patients with HSP were randomly divided into two groups,the observation group with 36 cases,the control group with 30 cases.Observation group were given leflunomide 20 mg/d,while control group were not given leflunomide,two groups were given oral glucocorticoid 0.5-0.6mg/（kg·d）at the same time and the dosage was reduced 4weeks later.The total course of treatment was 6months and the follow-up time ranged from 6-12 months.Blood and urine routine,ALT,AST,serum creatinine,blood glucose were monitored.Three months and six months after treatment was selected as observation points,urine red blood cell count recorded was respectively to evaluate the efficacy of leflunomide.Results：After treatment,the red blood cell count of urine in two groups were significantly decreased（P〈0.05）.After 3,6 months of treatment,the red blood cell count of urine in observation group were significantly decreased compared with the control group（P〈0.05）.According to the comparision of two groups,the effect of observation group is obviously better than that of control group（P〈0.05）.Comparing the untoward effect and the incidence of the two groups,there was no significant difference（P 〉0.05）.Conclusion：Moderate dose glucocorticoid combined with leflunomide in the treatment of adult HSP under simple microscopic hematuria has good effect in reducing red blood cell count of urine,with obvious curative effect and low side effects,which can make the disease remission and reduce the recurrence rate.