来氟米特治疗难治性肾病综合征的临床观察  

Clinic effect of leflunomide on refractory primary nephrotic syndrome

作　　者：金南惠[1] 冯兵[2] 

机构地区：[1]重庆市第九人民医院肾内科,重庆400700 [2]第三军医大学新桥医院肾内科,重庆400037

出　　处：《西部医学》2009年第6期964-966,共3页Medical Journal of West China

摘　　要：目的评价来氟米特(LEF)治疗难治性原发性肾病综合征的有效性和安全性。方法按随机数字表将66例难治性原发性肾病综合征患者分为LEF组和环磷酰胺(CTX)组,LEF组34例,给予LEF(20 mg/d)联合中等剂量激素(30 mg/d)治疗;CTX组32例,给予CTX(600 mg/2w,iv)联合中等剂量激素(30 mg/d)治疗,共持续6个月。观察24 h尿蛋白定量、肾功能、肝功能、血常规等指标的变化及不良反应发生情况。结果LEF治疗6个月,总有效率为87.5%,其中完全缓解22例(64.7%),显著缓解6例(17.6%),部分缓解3例(8.8%),无效3例(12.5%)。而CTX组总有效率为81.2%,其中完全缓解16例(50%),显著缓解4例(12.5%),部分缓解6例(18.8%),无效例6(18.8%)。LEF组在完全缓解和显著缓解率较CTX组显著(P<0.05)。LEF治疗对微小病变和轻度系膜增生型难治性肾综有效率为93.75%和92.3%,而对膜性肾病有效率为60%,存在显著性差异(P<0.05)。与CTX组比较,治疗3个月时,LEF组24h尿蛋白显著低于CTX组,血浆总蛋白和血浆白蛋白均显著高于CTX组。LEF和CTX均显著减少血清中TNFα和IL-1含量,两组间无显著差异。LEF组总不良反应发生率为8.8%,而CTX组为43.8%,存在显著性差异(P<0.05)。结论来氟米特是一种治疗难治性原发性肾病综合征有效的免疫抑制剂,且耐受性良好,不良反应小,疗效优于环磷酰胺。Objective To investigate the clinical efficacy and safety of leflunomide in refractory primary nephrotic syndrome. Method Sixty-six patients with refractory primary nephrotic syndrome were involved in this study. Thirtyfour patients were treated with leflunomide combined with prednisone for six months. The other thirty-two patients were treated with cyclophosphamide combined with prednisone for six months. The efficacy was assessed by subsequent changes in total of 24h urine protein, liver function and kidney function. Results In the group of leflunomide, the total effective rate was 8.5% and the rate of complete clinical remission （CCR） and significant clinical remission（SCR） and partial clinical remission（PCR） was 64.7%, 17. 6% and 8. 8%, respectively. In the group of eyclophosphamide, the total effective rate was 81.2% and the rate of CCR and SCR and PCR was 50%, 12.5% and 12.5%, respectively. The total rate of complete clinical remission and significant clinical remission in LEF group was markedly higher than that in CTX group. The effective rate was 93.75% and 92.3% in subgroup of minimal change disease（MCD） and mesangial proliferative glomerulonephritis （MsPGN）, which was significantly higher than 60% in the group of membranous nephropathy （MN）. Compared with CTX, total of 24h urine protein was low, and the amount of total plasma protein and plasma albumin was high. The concentration of serum TNF and IL-1 could be reduced equally by LEF and CTX treatment. The total rate of side-effect in LEF group （8.8%） was significantly lower than that in CTX group（43.8%）. Conclusion Leflunomide is more effective and safe in treatment of refractory primary nephrotic syndrome than cyclophosphamide.

关 键 词：难治性肾病综合征 来氟米特 环磷酰胺 

分 类 号：R692.5[医药卫生—泌尿科学]