环磷酰胺联合来氟米特治疗狼疮肾炎45例疗效观察

Clinical efficacy of cyclophosphamide combined with leflunomide in the treatment of lupus nephritis in 45 patients

目的:探讨环磷酰胺联合来氟米特治疗狼疮肾炎的临床疗效。方法:回顾性分析聊城市第二人民医院2019年1月至2020年6月收治的狼疮肾炎患者90例的临床资料,依据治疗方法不同分为两组,单一用药组(n=45)单独使用环磷酰胺治疗,联合用药组(n=45)采用环磷酰胺联合来氟米特治疗,两组疗程6个月,比较两组总有效率、炎性因子水平、免疫功能、肾功能及不良反应。结果:联合用药组总有效率为95.56%(43/45),高于单一用药组的82.22%(37/45),差异有统计学意义(χ^(2)=4.05,P<0.05)。治疗后,联合用药组白细胞介素6、C反应蛋白、类风湿因子分别为(45.21±5.07)ng/L、(3.13±1.01)mg/L、(43.37±18.20)IU/mL,均低于单一用药组的(60.20±6.13)ng/L、(6.23±1.31)mg/L、(73.19±19.17)IU/mL(t=12.64、12.57、7.56,均P<0.001);联合用药组免疫球蛋白A、免疫球蛋白G、免疫球蛋白M均较单一用药组明显改善(t=13.05、13.40、13.51,均P<0.001);联合用药组血肌酐、24 h尿蛋白定量分别为(78.23±19.13)μmol/L、(1.15±0.33)g/24 h,均低于单一用药组的(92.19±20.19)μmol/L、(3.15±0.81)g/24 h(t=3.36、15.33,均P<0.001)。联合用药组不良反应发生率为6.67%(3/45),低于单一用药组的22.22%(10/45),差异有统计学意义(χ^(2)=4.40,P<0.05)。结论:环磷酰胺联合来氟米特治疗狼疮肾炎的临床疗效确切,可调节机体炎性反应,改善免疫功能,促进肾功能恢复,且用药安全。

Objective To investigate the clinical efficacy of cyclophosphamide combined with leflunomide in the treatment of lupus nephritis.Methods The clinical data of 90 patients with lupus nephritis who received treatment in The Second People's Hospital of Liaocheng from January 2019 to June 2020 were retrospectively analyzed.These patients were divided into two groups according to different treatment methods.The single drug group(n=45)was treated with cyclophosphamide alone,and the combined drug group(n=45)was treated with cyclophosphamide combined with leflunomide.All patients were treated for 6 months.Total response rate,inflammatory factor level,immune function,renal function,and adverse reactions were compared between the two groups.Results Total response rate in the combined drug group was 95.56%(43/45),which was significantly higher than 82.22%(37/45)in the single drug group(χ^(2)=4.05,P<0.05).After treatment,interleukin-6,C-reactive protein,and rheumatoid factor in the combined drug group were(45.21±5.07)ng/L,(3.13±1.01)mg/L,(43.37±18.20)IU/mL,respectively,which were significantly lower than(60.20±6.13)ng/L,(6.23±1.31)mg/L,(73.19±19.17)IU/mL in the single drug group(t=12.64,12.57,7.56,all P<0.001).Immunoglobulin A and immunoglobulin G levels in the combined drug group were significantly lower than those in the single drug group(t=13.05,13.40,both P<0.001),but immunoglobulin M level in the combined drug group was significantly higher than that in the single drug group(t=13.51,P<0.001).Serum creatinine and 24-hour urine protein levels in the combined drug group were(78.23±19.13)μmol/L and(1.15±0.33)g/24 hours,respectively,which were significantly lower than(92.19±20.19)μmol/L and(3.15±0.81)g/24 hours in the single drug group(t=3.36,15.33,both P<0.001).The incidence of adverse reactions in the combined drug group was 6.67%(3/45),which was significantly lower than 22.22%(10/45)in the single drug group(χ^(2)=4.40,P<0.05).Conclusion Cyclophosphamide combined with leflunomide is effective against lupus nephritis.The combined therapy can regulate the inflammatory reaction,improve the immune function,promote the recovery of renal function,and be safe.