论文部分内容阅读
目的比较来氟米特与环磷酰胺诱导治疗狼疮性肾炎的疗效、不良反应及安全性。方法选择2009年1月—2012年6月收治的狼疮性肾炎患者43例,随机分为治疗组21例和对照组22例,对照组采用环磷酰胺冲击治疗方案,环磷酰胺0.75 g/m2静脉滴注,每月1次,持续6个月,病情改善后改为3个月1次;治疗组采用来氟米特治疗,开始时全部患者均给予负荷量50 mg/d口服,连用3 d后改为20 mg/d维持治疗。以上两种方案均没有同时合用其他免疫抑制剂。6个月后行疗效和安全性评价。计量资料用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果对照组治疗3、6个月时,24 h尿蛋白定量、补体、抗ds-DNA抗体及系统性红斑狼疮DAI评分都有显著改善。治疗组治疗3、6个月时,疗效与对照组相似,临床观察指标与免疫学指标均有显著改善,但两组间比较差异无统计学意义(均P﹥0.05)。对照组总有效率68.1%,治疗组总有效率71.4%,两组比较差异无统计学意义(P>0.05)。对照组不良反应发生率18.1%,治疗组不良反应发生率14.2%,给予对症支持治疗后均可继续用药。结论来氟米特联合泼尼松可以降低狼疮性肾炎尿蛋白定量、抗ds-DNA抗体滴度、血肌酐水平;提高补体C3水平,其疗效有待于大型前瞻性研究进行验证。
Objective To compare the efficacy, side effects and safety of leflunomide and cyclophosphamide in the treatment of lupus nephritis. Methods Forty-three patients with lupus nephritis who were admitted to our hospital from January 2009 to June 2012 were randomly divided into treatment group (n = 21) and control group (n = 22). The control group was treated with cyclophosphamide shock treatment, cyclophosphamide 0.75 g / Intravenous infusion, once a month, for 6 months, the condition improved to 3 months 1; treatment group leflunomide treatment, all patients were initially given a load of 50 mg / d orally, once every 3 d later changed to 20 mg / d maintenance treatment. The above two programs are not combined with other immunosuppressive agents. Efficacy and safety evaluation after 6 months. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results In control group at 3 and 6 months, 24 h urinary protein, complement, anti-ds-DNA antibody and systemic lupus erythematosus DAI scores were significantly improved. At 3 and 6 months after treatment, the curative effect in the treatment group was similar to that in the control group, and both the clinical observation and the immunological indexes were significantly improved. However, there was no significant difference between the two groups (all P> 0.05). The total effective rate of the control group was 68.1%, and the total effective rate of the treatment group was 71.4%. There was no significant difference between the two groups (P> 0.05). The incidence of adverse reactions in the control group was 18.1%, and the incidence of adverse reactions in the treatment group was 14.2%. The patients who received symptomatic supportive therapy could continue the medication. Conclusions Leflunomide combined with prednisone can reduce urinary protein, anti-dsDNA antibody titer and serum creatinine in patients with lupus nephritis. To improve the level of complement C3, the efficacy of leflunomide and prednisone remains to be validated in a large prospective study.