来氟米特治疗过敏性紫癜性肾炎的临床研究  

Clinical study of new immunosuppresant leflunomide on treatment of henoch-sch6nlein purpura nephritis

作　　者：任岳钦[1] 李延国[1] 马云航[1] 

机构地区：[1]山东省临沂市人民医院肾内科,临沂276003

出　　处：《临床肾脏病杂志》2005年第4期169-171,共3页Journal Of Clinical Nephrology

基　　金：2004年临沂市科技发展计划（0434036）

摘　　要：目的 前瞻性观察来氟米特治疗不同病理类型的过敏性紫癜性肾炎（HSPN）的临床疗效。方法 将60例HSPN患者随机分为两组，治疗组每日给予来氟米特50mg，3d后改为20mg，完全缓解后减量至10mg，维持3个月；对照组给予传统的激素和抗过敏治疗（泼尼松每日30-50mg，尿蛋白完全消失后2周起逐渐减量至最小维持量）。两组均可加护肾、抗凝、降血压等药物治疗，3个月后分析结果。结果 治疗组24h尿蛋白定量、尿红细胞数明显减少，血浆白蛋白含量明显升高，与对照组的差异有统计学意义（P〈0．05），血肌酐浓度则无明显改变（P〉0．05）。治疗组完全缓解率为73．3％，明显高于对照组的46．7%／6（P〈0．05），副作用较少。结论 来氟米特治疗HSPN近期治愈率高，安全性好；远期疗效及安全性有待进一步探讨。Objective To investigate the clinical effects of leflunomide as a new immunosuppressire agent on Henoch-schoenlein purpura nephritis（HSPN） and the response of on different pathological types of HSPN. Method Sixty patients with HSPN were divided into two groups randomly. Patients in leflunomide group were administerated with leflunomide with a dosage of 50 mg/d for three days, followed by 20 mg/d until complete remission, then leflunomide would be 10 mg/d, the total course of leflunomide was 3 months. Patients in the control group received traditional anti-allergic treatment and glucocorticoid, the dose of prednisone was 30-50 mg/d which were decreased as clinical improvement has had achieved. Urine and blood routine examinations as well as 24 hours urine protein, hepatic and renal function were investigated periodically. Patients were evaluated for efficacy and safety after 3 months. Results In leflunomide group 24 hour urinary protein excretion （from 2644. 7 mg ± 1134. 9 nag to 522. 3 mg ± 460. 8 mg） and uriary RBC（from 14. 2/HP ± 6. 3/HP to 4. 7/HP ± 4. 3/ HP） decreased more significantly than that [24 hour urinary protein excretion（from 2456. 3 mg ± 986. 4 mg to 808. 3 mg± 607. 0 mg） and urinary RBC（from 14. 8/HP ± 5. 8/HP to 7. 9/HP ± 7. 5/ HP）] in control group （P〈0. 05）, serum albumin increased more significantly in leflunomide group than that in control group （P〈0. 05）, Serum creatinine remained stable in both leflunomide group （from 88. 32 μmol/L ± 35.46 μmol/L to 81.32 μmol/L ± 14. 96 μmol/L） and control group （89. 21 μmol/L ± 26. 8 μmol/L to 83. 31 μmol/L ± 16. 90 μmol/L） （P〉0. 05）. The complete remission rate（73. 3 %） in leflunomide group was more than that（46. 7%） in control group（P〈0. 05）. The side effects were mild and all the patients could tolerate. Conclusions Leflunomide is an effective immunosuppressant in treating HSPN and is well tolerated, long term efficacy and safety of leflunomide remain to be observed.

关 键 词：来氟米特 药物治疗 过敏性紫癜性肾炎 泼尼松 血肌酐 

分 类 号：R692.3[医药卫生—泌尿科学] R983[医药卫生—外科学]