吗替麦考酚酯联合来氟米特及醋酸泼尼松治疗难治性肾病综合征的临床疗效

Clinical effect of mycophenolate mofetil combined with leflunomide and prednisone acetate in treating refractory nephrotic syndrome

目的探讨吗替麦考酚酯联合来氟米特及醋酸泼尼松治疗难治性肾病综合征(RNS)的临床疗效。方法选取护理职业技术学院附属医院2014年4月—2017年10月收治的RNS患者69例,采用随机数字表法分为对照组(n=34)和观察组(n=35)。两组患者均给予常规治疗,对照组患者在常规治疗基础上给予来氟米特治疗,观察组患者在对照组基础上给予吗替麦考酚酯治疗,两组患者均持续治疗6个月。比较两组患者临床疗效及治疗前后肾功能指标[24 h尿蛋白定量(24 hpro),血清蛋白(Alb)]、尿炎性因子[白介素6(IL-6)、白介素8(IL-8)]水平,并观察两组患者复发情况。结果观察组患者总有效率高于对照组(P<0.05)。治疗前两组患者24 hpro、Alb水平及尿IL-6、IL-8水平比较,差异无统计学意义(P>0.05);治疗后观察组患者24 hpro及尿IL-6、IL-8水平低于对照组,Alb水平高于对照组(P<0.05)。两组患者复发率比较,差异无统计学意义(P>0.05)。结论吗替麦考酚酯联合来氟米特及醋酸泼尼松治疗RNS的临床疗效确切,能有效改善患者肾功能,减轻炎性反应,且可降低远期复发风险。

Objective To investigate the clinical effect of mycophenolate mofetil combined with leflunomide and prednisone acetate in treating refractory nephrotic syndrome(RNS).Methods A total of 69 cases patients with RNS were selected from April 2014 to October 2017 in Affiliated Hospital of Vocational and Technical College of Nursing,which were divided into control group(n=34)and observation group(n=35)according to random number table.Both groups were given routine treatment,control group were given leflunomide on the basis of routine treatment,while observation group were given mycophenolate mofetil on the basis of control group,both groups were treated for 6 months.The clinical effect,and the levels of renal function indexes(24 hpro,Alb),urinary inflammatory factors(IL-6,IL-8)before and after treatment were compared between the two groups,and the recurrence was observed.Results The total effective rate of observation group was higher than control group(P<0.05).Before treatment,there was no significant differences in 24 hpro,ALB levels,urinary IL-6 or IL-8 levels between the two groups(P>0.05);after treatment,observation group of 24 hpro levels,urinary IL-6 and IL-8 levels were lower than control group,and Alb levels was higher than control group(P<0.05).There was no significant difference in recurrence rate between the two groups(P>0.05).Conclusion Mycophenolate mofetil combined with leflunomide and prednisone acetate have an obviously clinical effect in treating RNS,which can improve renal function of patients,alleviate inflammatory response,and with low risk of long-term recurrence.