来氟米特治疗Ⅳ期糖尿病肾病的效果观察  

Clinical observation of leflunomide in the treatment of diabetic nephropathy - IV

作　　者：魏玮[1] 王慧敏[1] 

机构地区：[1]中国医科大学第五临床学院本钢总医院肾内科,本溪117000

出　　处：《中国综合临床》2013年第11期1199-1202,共4页Clinical Medicine of China

摘　　要：目的观察来氟米特治疗Ⅳ期糖尿病。肾病（DN）的临床效果。方法选取Ⅳ期DN患者60例，应用随机数字表分为来氟米特治疗组和对照组，两组均给予降糖、降压、调脂及血管紧张素转换酶抑制剂或血管紧张素Ⅱ抑制剂类药物治疗，治疗组同时给予来氟米特治疗，前3d为50mg／次、1次／d口服，3d后改为20mg／次、1次／d口服，维持治疗2个月。观察两组患者治疗前后24h尿蛋白定量、C反应蛋白（CRP）、内生肌酐清除率（Ccr）、甘油三酯（TG）、总胆固醇（TC）、白蛋白（ALB）、糖化血红蛋白（HbAlC）及血压情况。分析治疗1年后Ccr与各指标的相关性。结果治疗组入选26例，治疗前、治疗2个月及治疗1年的24h尿蛋白定量分别为（3．75±0．94）、（2．02±0．45）、（2．46±0．55）g／24h，Ccr分别为（69．04±13．35）、（71．35±11．25）、（67．48±10．58）mlfmin；对照组入选28例，3个时间点24h尿蛋白定量分别为（3．68±1．03）、（3．43±0．65）、（5．46±0．47）g／24h，Ccr分别为（68．55±10．09）、（66．76±9．45）、（57．50±15．75）mlfmin，治疗组治疗2个月、治疗1年时24h尿蛋白低于治疗前，并低于同期对照组，而CCR高于对照组同期，差异均有统计学意义（P均〈0．05）；治疗组治疗2个月、1年时CRP、TG、TC、HbAle、收缩压与治疗前和对照组同期比较明显降低，血ALB与治疗前和对照组同期比较明显升高，差异均有统计学意义（P均〈0．05）。治疗1年后两组患者24h尿蛋白定量、TC、收缩压与Ccr呈显著负相关（X2值分别为-0．771、-0．682、-0．530，P均〈0．01）；血ALB与Ccr呈正相关（x2=0．656，P〈0．01）。结论来氟米特治疗DN安全有效，但治疗维持时间及是否适时再次选用来氟米特治疗有待于进一步深入研究。Objective To investigate the curative effect of leflunomide in the treatment of diabetic nephropathy-lV （DN-IV）. Methods Sixty cases with DN-1V were assigned to the leflunomide treatment group and the control group. Both groups were given hypoglycemic, antihypertensive, regulate lipid and angiotensin converting enzyme inhibitors or angiotensin 11 inhibitor class of drugs. Meanwhile patients in the treatment group were orally administered leflunomide once daily for two month with a dose of 50 mg/d in the first three days and 20 mg/d afterwards. 24 hour pre- and post-treatment values of urinary protein, C-reactive protein （CRP） , endogenous creatinine clearance rate （ Ccr）, triglyceride （TG） , total cholesterol （ TC ）, albumin （ ALB ）, glycosylated hemoglobin （HbA1 c） and blood pressure were measured. Analyzed the correlation of Ccr with other laboratory indicators after treatment for one year. Results At 24 hour before treatment, after treatment for two months and one year, the level of 24 h urinary protein of the treatment group （ n = 26 ） were （ 3.75 ± 0. 94） 5/24 h, （2. 02 ± 0. 45 ） 5/24 h, and （ 2.46 ± 0. 55 ） 5/24 h respectively, and the level of Cer were （ 69. 04 ± 13.35 ） ml/min, （71.35 ± 11.25 ） ml/min, and （67.48 ___ 10. 58 ） ml/min respectively. While in the control group（ n = 28 ） , the 24 h urinary protein level of were （ 3.68 ~ 1.03 ） 5/24 h, （ 3.43 ± 0. 65 ） 5/24 h, and （ 5.46 ± 0.47 ） 5/24 h respectively at the three time points, and the Ccr level were （ 68.55 ± 10.09 ） ml/min, （66. 76 ± 9.45 ） ml/min, （57.50± 15.75） ml/min respectively. The levels of 24 h urinary protein in the treatment group after treatment for two months and one year were significantly lower than before treatment in the treatment group as well as at the corresponding period of the control group （ P 〈 0. 05 ）, while the level of Ccr in the treatment group was higher than that of the control group at the same period, and the differe

关 键 词：糖尿病肾病 来氟米特 内生肌酐清除率 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]