泼尼松联合来氟米特治疗IgA肾病的近远期疗效观察

Short-term and Long-term Efficacy of Prednisone Combined with Leflunomide in the Treatment of IgA Nephropathy

目的观察泼尼松联合来氟米特治疗IgA肾病的近远期疗效及安全性。方法将2016年1—12月收治的IgA肾病80例,按治疗方法分为观察组和对照组各40例。对照组给予泼尼松治疗,观察组给予来氟米特联合泼尼松治疗,治疗疗程均为3个月。比较2组总有效率及治疗前、治疗后、随访结束时(随访时间1~2年)24 h尿蛋白定量、肾小球滤过率、血肌酐(SCr)、血尿素(BUN)、白蛋白水平及镜下红细胞数变化,记录并比较2组不良反应发生情况。结果治疗后及随访结束时观察组总有效率均显著高于对照组(P<0.05);治疗后及随访结束时观察组24 h尿蛋白定量、SCr、BUN及镜下红细胞数显著低于对照组,肾小球滤过率、白蛋白水平显著高于对照组(P<0.05);观察组不良反应发生率显著低于对照组(P<0.05)。结论泼尼松联合来氟米特治疗IgA肾病较单用泼尼松治疗能更加显著的降低尿蛋白,升高白蛋白,疗效稳定、确切,延缓肾功能进展的作用更显著,安全性更佳。

Objective To observe the short-term and long-term efficacy and safety of Prednisone combined with Leflunomide in the treatment of IgA nephropathy.Methods Patients with IgA nephropathy admitted to our hospital from January 2016 to December 2016 were divided into observation group and control group according to the therapeutic method,with 40 cases in each group.Control group was treated with Prednisone,and observation group was given Leflunomide combined with prednisone.The course of treatment was 3 months.The total effective rate,and levels of 24 h urine protein quantitation,glomerular filtration rate(GFR),serum creatinine(SCr),blood urea nitrogen(BUN)and albumin and the number of red blood cells under microscope before treatment,after treatment and at the end of follow-up(1 to 2 years of follow-up)were compared between the two groups.The incidence rate of adverse reactions was recorded and compared between the two groups.Results After treatment and at the end of follow-up,the total effective rate was higher in observation group than in control group(P<0.05).After treatment and at the end of follow-up,the 24 h urine protein quantitation,SCr,BUN and quantity of red blood cells under microscope in observation group were lower than those in control group,while the GFR and albumin level were higher than those in control group(P<0.05).The incidence rate of adverse reactions in observation group was lower than that in control group(P<0.05).Conclusion Prednisone combined with Leflunomide for IgA nephropathy can more significantly reduce urinary protein and increase albumin than prednisone alone,which has stable and precise efficacy.In addition,it can delay the progression of renal function more significantly and has better safety.