激素联合来氟米特或环磷酰胺治疗慢性进展性IgA肾病的比较

目的：比较激素联合环磷酰胺（CTX）或来氟米特 （LEF）治疗慢性进展性IgA肾病（IgAN）的疗效及安全性.方法：回顾性分析2009年6月~2012年7月在我院确诊为IgAN患者,Lee氏分级Ⅱ级或以上,并应用激素分别联合CTX或LEF治疗的患者57例,CTX组25例,LEF组32例;收集患者治疗前及每月随访资料.结果：经治疗IgAN尿蛋白总缓解率达87.7%,治疗期间CTX组和LEF组尿蛋白部分缓解分别为7例（28.0%）和11例（34.4%）,P=0.607;CTX组和LEF组尿蛋白完全缓解分别为14例（56.0%）和18例（56.2%）,P=0.985.CTX组和LEF组部分缓解时间分别为（2.95±1.70）月和 （3.27±3.01）月,差异有统计学意义（P=0.048）,CTX组和LEF组尿蛋白完全缓解时间分别为（5.45±3.31）月和（6.69±5.82）月,P=0.052.随访中CTX组副反应发生率12.0%,LEF组副反应发生率6.25%.结论：激素联合CTX或LEF治疗慢性进展性IgAN均有相同的疗效,CTX组部分缓解时间较LEF快,长期疗效及安全性有待进一步观察.

Cyclophosphamide Versus Leflunomide Combined with Prednisone Respectively in Treatment of Chronic Progressive IgA Nephropathy

Objective：To compare the efficacy and safety of cyctophosphamide （CTX） or leflunomide （LEF） combined with prednisone respectively in treatment of chronic progressive IgA nephropathy （IgAN）. Methods：A retrospective analysis about 57 IgAN patients from June 2009 to July 2012 , which were Lee＇s grade II or above, and treated with CTX（25cases）or LEF（32cases） combined to prednisone respectively, clinical datas were collected before treatment and during monthly follow -up. Results：The over- all 24h urine protein remission rate of the two groups was 87.7%, The partial remission rate of CTX group and LEF group were7 cases （28.0%） and 11 cases （34.4%） respectively （ P = 0. 607 ）, complete remission rate of that were 14 cases （ 56.0% ） and 18 （56.2%） respectively（ P = 0.985 ）. CTX group and LEF group partial remission time was （2.95 ± 1.70） month and （3.27 ± 3.01 ） month respectively, the difference was statistically significant （P = 0.048）, the complete remission time was （5.45 ± 3.31 ）month and （6.69±5.82）month （P =0.052）. During follow - up ,there was 12.0% incidence of side effects in CTX group and 6.25% in LEF group. Conclusion：The treatment with CTX or LEF combined prednisone in chronic progressive IgAN has the same effect, Partial remission time in CTX group is faster than that in LEF group, the long -term efficacy and safety remains to be clarified.