来氟米特联合泼尼松治疗表现为肾病综合征局灶节段性肾小球硬化的临床观察

目的观察来氟米特联合泼尼松治疗表现为肾病综合征局灶节段性肾小球硬化（focalsegmental glomerulosclerosis，FSGS）患者的疗效及安全性。方法将60例局灶节段性肾小球硬化肾病综合征患者随机分为2组：来氟米特（1eflunomicle，LEF）治疗组30例、环孢素（cyclosporinA，CsA）组30例。LEF组开始治疗后，前3d予LEF50mg／d，3d后改为维持剂量30mg／d）CsA组予以CsA1．5～2．5mg·kg-1·d-1，根据血药浓度逐渐增加剂量。2组患者同时使用泼尼松0．5mg·kg-1·d-1，并逐渐减量。观察治疗前、治疗后第4、8、12周及第6、12个月的24h尿蛋白定量、肝功能、肾功能、血脂等临床指标以及不良反应。结果LEF组30例患者均完成了一年的治疗观察，CsA组30例患者有一例因药物副反应退出治疗，其余29例患者完成了治疗。2组患者治疗后24h尿蛋白定量明显减少，血白蛋白升高，与治疗前相比，差异均有统计学意义（P〈O．05）。LEF组治疗后第6个月时总有效率70．00％（21／30），治疗后第12个月时总有效率76．67％（23／30）；CsA组治疗后第6个月时总有效率75．86％（22／29），治疗后第12个月时总有效率68．97％（20／29），2组比较差异无统计学意义（P〉0．05）。LEF组不良反应轻微，患者耐受性良好。结论LEF是治疗表现为肾病综合征的FSGS患者的一种安全有效药物。

Clinical analysis of leflunomide combined with prednisone for refractory nephritic syndrome with focal segmental glomerulosclerosis

Objective To investigate the safety and clinical efficacy of leflunomide combined with prednisone in the treatment of refractory nephritic syndrome with focal segmental glomeruloscle- rosis. Methods Sixty patients with refractory nephritic syndrome were randomly divided into two groups.. 30 patients treated with leflunomide combined with prednisone, and 30 patients in control group were treated with cyclosporin A combined with prednisone. Patients were observed before and 4 weeks, 8 weeks, 12 weeks, 6 month and 12 months after treatment. 24-h urinary protein, liver and kidney function and blood fat were assayed,and the rate of adverse reactions during treatment was re- corded. Results All the patients completed treatment in Leflunomide and prednisone treatment group, and treatment was given up because of adverse reactions in ciclosporin A and prednisone treat- ment group. The increase of serum albumin and decrease of urinary protein were significant in Lefluno- mide and prednisone treatment group （P〈0. 05）, but there was no significant difference in remission rate between two groups （P〉0. 05）. Conclusions Leflunomide combined with prednisone treatment can relieve refractory nephritic syndrome with focal segmental glomerulosclerosis.