来氟米特治疗老年糖尿病肾病的临床研究

目的探讨来氟米特片对老年糖尿病肾病的临床疗效。方法将86例老年糖尿病肾病患者随机分为2组。对照组采用常规降压、降糖治疗,治疗组患者增加来氟米特片,口服,首剂量50 mg/次,1次/d,连续3 d后改为20 mg/次,1次/d,连续治疗4周。比较两组患者疗效及炎性因子、基质金属蛋白酶-2（MMP-2）和β2-微球蛋白（β2-MG）变化。结果治疗组缓解率86.05%,对照组74.42%,两组比较差异具有统计学意义（P〈0.01）;治疗后两组患者血糖均达到控制目标,尿蛋白定量、血清白蛋白（ALB）、肌酐（Cr）、尿素氮（BUN）均明显好转（P〈0.05）,与对照组比较,治疗组改善更为显著,差异具有统计学意义（P〈0.01）;治疗后两组白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、高敏C-反应蛋白（hs-CRP）差异均有统计学意义（P〈0.05）;治疗后两组患者MMP-2和β2-MG与治疗前比较差异均有统计学意义（P〈0.05）,但只有两组MMP-2差异有区别（P〈0.05）。结论来氟米特片对糖尿病肾病患者的肾功能具有保护作用,其机制可能与机体炎症刺激状态和MMP-2的合成有关。

Clinical study of Leflunomide Tablets in treatment of elderly diabetic nephropathy

Objective To investigate the clinical effect of Leflunomide Tablets on diabetic nephropathy. Methods Patients（86 cases） were randomly divided into two groups. Patients in the control group were given conventional antihypertensive and antidiabetic treatment. Patients in the treatment group were po administered with Leflunomide Tablets with the first dosage of 50 mg/time, once daily, and rested for 3 d. Then the administration was repeated to 20 mg/time, once daily for 4 weeks. Clinical effect and changes of inflammatory factors, MMP-2, and β2-MG in the two groups were compared. Results The significant remission rates in the treatment and control groups were 86.05% and 74.42%, respectively, and there were differences between the two groups（P〈0.01）. After treatment, blood glucose in the two groups reached control goal, and urine protein, ALB, Cr, and BUN were improved significantly（P〈0.05）. The parameters in the treatment group were improved more significantly than those in the control group, and the differences were statistically significant（P〈0.01）. After treatment, these levels of IL-6, TNF-α, and hs-CRP in the treatment group were improved better than those of control group with significant difference between the two groups（P〈0.05）. There were differences of MMP-2 and β2-MG levels between the two groups after treatment（P〈0.05）, but only levels of MMP-2 in the two groups had difference（P〈0.05） Conclusion Leflunomide Tablets have protective effect on renal function in patients with diabetic nephropathy, and the mechanism may be related to inflammatory stimulation and MMP-2 generation.