来氟米特治疗肾病综合征表现的紫癜肾临床观察

目的观察激素联合来氟米特治疗表现为肾病综合征的紫癜肾，探讨来氟米特的疗效及安全性。方法选择过敏性紫癜性肾炎患者38例，男20例，女18例，平均年龄（26．2±10．6）岁，均符合肾病综合征诊断标准，随机分为来氟米特治疗组和环磷酰胺对照组。来氟米特治疗组19例，给予口服来氟米特50mg／d，3d后20mg／d维持，激素用量1mg／（kg·d）、服8周后减量；环磷酰胺对照组19例采用环磷酰胺，每半月冲击一次，总量达到150mg／kg，激素服药方法同治疗组。观察治疗后各组患者24h尿蛋白定量、尿沉渣红细胞数目、血浆白蛋白水平。结果用药后3个月及6个月两组24h尿蛋白定量较治疗前均显著下降，血浆白蛋白水平显著升高，尿沉渣红细胞计数明显减少（P〈0．05）。3个月后来氟米特治疗组较环磷酰胺对照组疗效差异无显著性（P〉0．05），但6个月后疗效治疗组较对照组有明显统计学意义（P〈0．05）。结论来氟米特是治疗表现为肾病综合征的紫癜肾的一种安全有效的药物，优于环磷酰胺。

Leflunomide in treating purpura nephritis with nephritic syndrome

Objective To observe the efficacy and safety of leflunomide in treating purpura nephritis with nephrotic syndrome （NS）. Methods 38 allergic purpura nephritis patients were randomly chosen, including 20 male and 18 female, with a mean age of 26.2 ± 10.6. 19 cases in the treatment group were given oral leflunomide 50 rag/d, three days later 20 mg/d, and the dosage of steroids was 1 mg/（kg · d）, with a taper over eight weeks. The 19 cases in the control group used cyclophosphamide to impinge every half a month, the total amount reached 150 mg/kg, and the steroids medication was the same as the treatment group. Then the 24-hour urine protein, the RBC count of urinary sediment, and plasma albumin level after treatment were observed. Results In both groups, 24-hour urine protein and the RBC count of urinary sediment were significantly decreased, and the serum albumin level were significantly increased （P〈0.05） after 3 and 6 months. There was no significant difference of effects in the first 3 months （P〉0.05）, but the treatment group was obviously more effective than the control group after 6 months （P〈0.05）. Conclusion This study data suggests that compared with cyclophosphamide, leflunomide is safer and more effective for the treatment of purpura nephritis with nephritic syndrome.