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目的观察来氟米特联合激素治疗伴肾功能不全的紫癜性肾炎,探讨来氟米特的疗效及安全性。方法选择紫癜性肾炎伴肾功能不全的住院患者77例,随机分为两组,A组39例,B组38例。A组给予口服来氟米特0.8mg/(kg·d),5d后改为维持量20mg/d;B组采用环磷酰胺0.75g/m2静脉滴注,每月1次,总量达到6～8g;同时,两组均给予泼尼松1mg/kg,口服8周减量,疗程6个月。观察治疗后各组患者24h尿蛋白定量、尿红细胞计数、Ccr、BUN等指标变化及药物不良反应。结果用药3、6个月后,两组24h尿蛋白定量、尿红细胞计数以及血肌酐水平较治疗前均显著下降,血浆白蛋白水平显著升高(P<0.05)。3个月后,A、B两组间的24h尿蛋白定量、尿红细胞计数及血浆白蛋白水平差异有统计学意义(P<0.05),但两组间的血肌酐水平差异无统计学意义(P>0.05)。6个月后,A、B两组间的24h尿蛋白定量、尿红细胞计数、血浆白蛋白水平和血肌酐水平差异均有统计学意义(P<0.05)。结论来氟米特是治疗过敏性紫癜性肾炎的一种安全有效的药物,优于环磷酰胺,且能延缓肾功能衰竭。
Objective To observe the combined treatment of leflunomide and renal insufficiency purpura nephritis, to explore the efficacy and safety of leflunomide. Methods 77 inpatients with purpura nephritis and renal insufficiency were randomly divided into two groups: 39 cases in group A and 38 cases in group B. Group A was given oral leflunomide 0.8mg / (kg · d), 5d after the maintenance dose of 20mg / d; Group B cyclophosphamide 0.75g / m2 intravenously once a month, the total amount of 6 ~ 8g; the same time, both groups were given prednisone 1mg / kg, 8 weeks oral reduction, treatment for 6 months. After treatment, the urinary protein excretion, urinary red blood cell count, Ccr, BUN and other adverse drug reactions were observed in all groups after treatment. Results After 3 and 6 months of treatment, the urinary protein excretion, urinary erythrocyte count and serum creatinine in both groups were significantly lower than those before treatment and plasma albumin level was significantly increased (P <0.05). After 3 months, there was a significant difference in 24h urinary proteinuria, urinary erythrocyte count and plasma albumin level between groups A and B (P <0.05), but there was no significant difference in serum creatinine between the two groups P> 0.05). After 6 months, the urinary protein excretion, urine red blood cell count, serum albumin level and serum creatinine level in group A and group B were significantly different (P <0.05). Conclusion Leflunomide is a safe and effective drug for the treatment of allergic purpura nephritis, which is superior to cyclophosphamide and can delay renal failure.