来氟米特联合环磷酰胺冲击治疗重症顽固性狼疮肾临床观察  

Efficacy and safety of leflunomide combined with pulse cyclophosphamide in treatment of severe and refractory lupus nephritis:a one year clinical trial

作　　者：张洪峰[1] 肖卫国[1] 侯平[1] 李舒帆[1] 王晓菲[1] 

机构地区：[1]中国医科大学附属第一医院风湿免疫科,沈阳110001

出　　处：《中国实用内科杂志》2010年第2期147-149,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察来氟米特联合环磷酰胺治疗重症顽固性狼疮肾的疗效及不良反应。方法选择中国医科大学附属第一医院风湿免疫科1999年1月至2009年4月重症顽固性狼疮肾患者42例,比较来氟米特联合环磷酰胺冲击(总量6g)治疗前后患者血清白蛋白,血清补体C3、C4,系统性红斑狼疮活动性指数(SLEDAI)及尿蛋白(g/24h)变化;观察来氟米特及环磷酰胺相关不良反应。结果补体C3在治疗后3个月时缓慢升高,但与治疗前比较差异无统计学意义(P>0.05),治疗后6个月,12个月明显升高(P<0.01);血清白蛋白、补体C4、系统性红斑狼疮活动性指数及尿蛋白在治疗后3个月、6个月及12个月好转明显(P<0.01)。不良反应有感染9例,恶心5例,转氨酶升高4例,血压升高2例,白细胞减少2例,血小板减少1例。结论来氟米特联合环磷酰胺冲击治疗重症顽固性狼疮肾疗效好、不良反应轻。Objective To assess efficacy and safety of leflunomide combined with pulse cyclophosphamide in the treatment of severe and refractory lupus nephritis （SRLN）. Methods From Jan. 1999 to April 2009, a total of 42 SRLN patients（ 16-50 years old） were treated in our hospital. After induced therapy with cyclophosphamide （total dose not less than 6. 0 g） in combination with steroids, the patients showed no responsiveness： the proteinuria reduction was less than 10% ,or still more then 3.5 g per day. The loading dose of leflunomide was 40 mg or 50mg once daily for the first 3 days, followed by maintenance dose of 40 mg or 50 mg twice weekly for two months, and then once a week, according to whether the body weight was less than 50 kg or not, whether the age was less than 18 years old or not, and disease severity, respectively. Pulse cyclophosphamide was intravenously given monthly for four times （0. 8 grams or 1.0 grams ）, then quarterly. All patients were prescribed oral prednisone 0. 8 - 1.0 mg/kg. Serum albumim, complement C3 and C4, systemic lupus erythematosus disease activity index （ SLE- DAI） and proteinuria were investigated at study entry,3 months ,6 months and 12 months, respectively. Results Thirty-nine cases were followed up for 12 months. Serum complement C3 increased slowly at 3 months, but had no difference compared with before treatment（ P 〉 0.05 ）, and increased quickly at 6 months and 12 months （ P 〈 0. 01 ）. Serum albumin, complement C4, SLEDAI and proteinuria were all significantly improved at 3 months, 6 months and 12 months （ P 〈 0. 01 ）. Adverse events included inflammation （ 9 cases）, nausea （4 cases）, elevated liver enzymes （ ALT or GGT, 4 cases）, hypertension （ 2 cases） , leukocytopenia （ 2 cases ） and thrombocytopenia （ 1 case ）. Conclusion Leflunomide shows good efficacy and mild adverse effects in combination with pulse cyclophosphamide in the treatment of SRLN patients.

关 键 词：来氟米特 环磷酰胺 狼疮肾 尿蛋白 

分 类 号：R5[医药卫生—内科学]