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目的评定来氟米特在治疗狼疮肾炎(LN)中的作用,分析两次肾活检肾脏病变类型的转化特点。方法经过来氟米特治疗LN并经过9～17个月后重复肾活检的21例LN,采用Katafuchi和Austin的评定标准,对肾小球、肾小管间质和血管病理变化和LN的活动性指数及慢性指数进行对比分析。结果①在第2次肾活检时,肾小球的节段性病变和肾小球的纤维素样坏死或“白金耳”改变与第1次有明显不同,但差异无统计学意义(P>0.05)。②LN的病变类型有转化,转化率43%,主要是Ⅳ型(70%)和Ⅴ型(40%)变化明显。③第2次肾活检有42%活动性指数下降,有53%(10/19)慢性指数有不同程度的升高。结论来氟米特首次用于治疗LN,并经重复肾活检证明病变类型有转化,由重转轻,活动性指数降低,可减缓疾病的进展,其作用机制有待于积累更多的重复肾活检病例验证。
Objective To evaluate the role of leflunomide in the treatment of lupus nephritis (LN) and to analyze the characteristics of two types of renal biopsy nephropathy. Methods Twenty-one patients with LN treated with leflunomide and repeated with renal biopsy 9 to 17 months later were assessed for glomerular, tubulointerstitial and vascular pathological changes and LN activity using Katafuchi and Austin criteria Index and chronic index comparative analysis. Results ① In the second renal biopsy, the segmental glomerular lesions and glomerular fibrinoid necrosis or “platinum ear” changes were significantly different from the first one, but the difference was not statistically significant (P> 0.05). ②LN lesions were transformed, the conversion rate of 43%, mainly type Ⅳ (70%) and type Ⅴ (40%) changes significantly. ③ The second 42% of renal biopsy decreased activity index, 53% (10/19) chronic index increased to varying degrees. Conclusions Leflunomide was first used in the treatment of LN, and repeated renal biopsy proved that the type of lesion was transformed. It changed from light weight to light and the activity index decreased, which could slow the progression of the disease. The mechanism of action needed to accumulate more repeated renal biopsy Case validation.