来氟米特联合甲泼尼龙片治疗特发性膜性肾病的疗效分析  

Effect of leflunomide combined with methylprednisolone on idiopathic membranous nephropathy

作　　者：尚顺来 李清刚[1] 陈香美[1] 

机构地区：[1]解放军总医院肾脏病科解放军肾脏病研究所肾脏疾病国家重点实验室国家慢性肾病临床医学研究中心,北京100853

出　　处：《解放军医学院学报》2018年第1期1-4,共4页Academic Journal of Chinese PLA Medical School

基　　金：国家科技支撑计划(2015BAI12B06);全军后勤"十二五"-重点项目(BWS14J040)~~

摘　　要：目的评估来氟米特(leflunomide,LEF)联合甲泼尼龙治疗特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床效果和安全性。方法选取2012年12月-2016年12月在本院肾病科肾穿病理诊断为IMN,并排除继发性肾病的患者60例,随机分为治疗组(30例,来氟米特联合甲泼尼龙治疗)和对照组(30例,他克莫司联合甲泼尼龙治疗),两组患者基线资料差异无统计学意义。监测治疗后4个月、8个月、12个月时的缓解率(完全缓解和部分缓解)、复发率、缓解时间、尿蛋白定量、血清白蛋白水平和肌酐水平变化,并评估不良反应。结果 60例IMN患者均完成了12个月观察。实验组和对照组4个月、8个月、12个月完全缓解率为分别为10.00%vs 13.33%、33.33%vs 46.67%、23.33%vs 20.00%,缓解率(完全缓解率+部分缓解率)分别为53.33%vs 46.67%、66.67%vs 56.67%、63.33%vs 60.00%,差异均无统计学意义(P均>0.05);12个月时对照组肌酐较基线以及实验组明显上升(P=0.029,P=0.007)。结论来氟米特联合甲泼尼龙治疗特发性膜性肾病安全有效。Objective To assess the clinical efficacy and safety of leflunomide （LEF） combined with methylprednisolone on idiopathic membranous nephropathy （IMN）. Methods Sixty patients who were diagnosed as IMN by renal biopsy from December 2012 to December 2016 in the department of nephrology in our hospital were enrolled, and they were randomly divided into experimental group （30 cases, treated by leflunomide combined with methylprednisolone）, and control group （30 cases, treated by tacrolimus combined with methylprednisolone）, There was no significant difference in baseline data between the two groups on enrollment. Remission rates （complete remission and partial remission）, relapse rates, remission duration, urinary protein quantitation, serum albumin levels, and creatinine levels were monitored at 4, 8 and 12 months after treatment and adverse events were assessed. Results At 4, 8 and 12 months, the complete remission rates in the experimental group and control group were 10.00% vs 13.33%, 33.33% vs 46.67% and 23.33% vs 20.00% （All P 〉 0.05）. The remission rates （complete remission rate and partial remission rate） in two groups had no significant difference, too （53.33% vs 46.67%, 66.67% vs 56.67% and 63.33% vs 60.00%; All P 〉 0.05）. At the 12th month, the creatinine in control group was significantly higher than that at baseline and in experimental group （P=0.029, P=0.007）. Conclusion The combination of LEF and methylprednisolone is an effective and safe therapy for IMN.

关 键 词：来氟米特 他克莫司 特发性膜性肾病 

分 类 号：R692[医药卫生—泌尿科学]