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目的:观察来氟米特联合雷公藤多甙治疗难治性肾病综合征(RNS)的疗效。方法:选取52例RNS患者随机分为观察组(32例)与对照组(30例),其中对照组给予来氟米特和激素联合治疗,观察组给予来氟米特配伍雷公藤多甙治疗。疗程均为6个月,治疗期间比较两组疗效,检测患者24h尿蛋白定量、血清总蛋白和白蛋白、血肌酐、血尿素氮、谷丙转氨酶变化情况,同时观察患者有无不良反应。结果:①治疗6个月后,观察组完全缓解率和总有效率分别为28.13%、78.13%,略高于对照组26.67%的完全缓解效率和76..67%的总有效率,但两组间差异无统计学意义(P>0.05)。②经过治疗,RNS患者24h尿蛋白定量逐渐下降,而血清总蛋白和白蛋白水平逐渐增加,与治疗前比较差异均有显著性(P<0.01),其中观察组各指标变化比对照组明显(P<0.05)③治疗后观察组与对照组患者尿素氮、血肌酐含量均较治疗前显著降低(P<0.01或0.05),而谷丙转氨酶水平无明显变化(P>0..05),两组间差异无显著性(P>0..05)。④观察组不良反应发生率为12.50%,明显低于对照组23.33%的发生率,组间差异有显著性(P<0.05)。结论:米氟米特联合雷公藤多甙治疗能明显缓解RNS患者的临床症状,改善肾功能,减少蛋白尿的产生,且短期内不良反应较少。
Objective: To observe the efficacy of leflunomide combined with tripterygium glycosides in the treatment of refractory nephrotic syndrome (RNS). Methods: Fifty-two patients with RNS were randomly divided into observation group (32 cases) and control group (30 cases). The control group was treated with leflunomide and hormone. The observation group received leflunomide combined with tripterygium glycosides . The course of treatment was 6 months. The curative effect of two groups was compared during treatment. The urinary protein excretion, serum total protein and albumin, serum creatinine, blood urea nitrogen and alanine aminotransferase in 24 hours were detected, and the adverse reaction was observed. Results: ① After 6 months of treatment, the complete remission rate and total effective rate in the observation group were 28.13% and 78.13%, respectively, slightly higher than the control group of 26.67% complete remission rate and 76..67% total effective rate, but two There was no significant difference between groups (P> 0.05). ② After treatment, 24 h urinary protein in RNS patients gradually decreased, while serum total protein and albumin levels gradually increased, compared with before treatment were significantly different (P <0.01), in which the changes in the indicators of the observation group was significantly ( (P <0.05 or P <0.05) .③The contents of blood urea nitrogen and serum creatinine in observation group and control group after treatment were significantly lower than those before treatment (P <0.01 or 0.05), while there was no significant change in alanine aminotransferase (P> 0.05) There was no significant difference between the two groups (P> 0..05). ④ The incidence of adverse reactions in the observation group was 12.50%, which was significantly lower than that in the control group (23.33%). There was significant difference between the two groups (P <0.05). Conclusion: The combination therapy of leflunomide and tripterygium wilfordii glycosides can relieve the clinical symptoms, improve the renal function and reduce the proteinuria in RNS patients with less side effects in short term.