来氟米特联合激素治疗过敏性紫癜性肾炎的疗效观察

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。

Clinical efficacy of combined leflunomide and hormone therapy for the treatment of allergic purpura nephritis

Objective To evaluate the safety and efficacy of combined leflunomide and hormone therapy for the patients with renal insufficiency of purpura kidney.Methods 77 inpatients with purpura nephritis and renal insufficiency were randomly divided into two groups：Group A（39 patients） was giving oral leflunomide 0.8 mg/（kg·d） for 5 days,and then the dosge was maintaining at 20 mg/d.Group B（38 patients） was giving cyclophosphamide 0.75 g/m2 intravenous drip once per month for 6 months and the total amount was 6～8 g.Both Group A and B were treating with prednisone 1 mg/kg at the same time;and the dosage was then reduced 8 months later.The levels of urinary proteins and red blood cell count,BUN and Ccr were monitored.Results At 3 to 6 months after the treatment,the levels of urinary protein,urinary red blood cell count and Ccr were significantly decreased and the level of plasma albumin was significantly increased（P〈0.05）.Six months later,the levels of urinary proteins,urinary red blood cell count and plasma albumin level in Group A patients were significantly different from Group B（P〈0.01）.The level of serum creatinine in Group A was also significantly different from Group B（P〈0.05）.Conclusion Leflunomide is a safe and effective drug for the patients with renal insufficiency of purpura kidney.