来氟米特联合糖皮质激素治疗IgA肾病的临床研究

目的 观察应用来氟米特（Leflunomide,LEF）联合激素治疗IgA肾病的疗效和安全性.方法 选择IgA肾病患者63例,分为LEF合并激素治疗组（LEF组）及大剂量激素治疗组（激素组）,观察治疗前和治疗6个月、12个月后的24 h尿蛋白定量、血清白蛋白、肾小球率过滤（eGFR）、收缩压、舒张压等实验室指标的变化,并进行疗效评价.结果 LEF组和激素组治疗6个月和12个月后的24 h尿蛋白定量、收缩压、舒张压均较治疗前显著下降（P＜0.05）,血清白蛋白水平较治疗前显著升高（P＜0.05）,2组eGFR变化均无统计学差异（P＞0.05）.治疗12个月后LEF组的总有效率明显高于激素组（P＜0.05）,而完全缓解率和部分缓解率的差异无统计学意义（P＞0.05）,2组不良反应无显著性差异（P＞0.05）.结论 LEF联合激素可以作为治疗IgA肾病的选择之一,且安全、有效.

Combined use of leflunomide and steroids for IgA nephropathy

Objective To investigate the efficacy and safety of combination of leflunomide （LEF） and steroids for IgA nephropathy. Methods Sixty-three cases of IgA nephropathy were divid- ed to LEF group treated with LEF and steroids, and steroids group treated with steroids alone. Rela- tive parameters were recorded before and 6 and 12 months after treatment. Efficacy was evaluated. Results At 6th and 12th month after treatment, 24-h urinary protein, systolic blood pressure and di- astolic blood pressure were significantly decreased （P0. 05 for all）, and serum albumin was signifi- cantly elevated as compared with those before treatment （P0.05）. eGFR had no statistically signifi- cant difference between these two groups （P0. 05）. Overall effective rate at 12th month after treat- ment was significantly higher in LEF group than in steroids group （P0. 05）, while there was no sig- nificant difference in complete remission rate and partial remission rate （P0. 05）. Adverse events were similar between these two groups. Conclusions The combination of LEF and steroids can be considered as one effective and safe option to treat IgA nephropathy.