小剂量莱氟米特治疗难治性肾病综合征的研究

目的：观察小剂量莱氟米特联合泼尼松治疗无效和复发的难治性肾病综合征的疗效和安全性。方法：60例患者用泼尼松0．8—1．0mg·kg-1·d-1治疗2个月无效后加用莱氟米特联合治疗（负荷剂量20mg·d-1×3d，维持量10mg·d-1×6月）。将泼尼松剂量迅速减至30mg·d-1。对照组用环磷酰胺（CTX）400mg，iv×2d冲击治疗每半月1次（总剂量不超过8．0g），同时联合应用泼尼松30～60mg·d-1治疗。观察4、8、24周的24h尿蛋白定量、肝肾功能、血常规及不良反应。结果：小剂量莱氟米特治疗后24h尿蛋白下降、血清白蛋白上升均高于CTX冲击治疗组（P〈0．01），肾功能变化不大。完全缓解率及总有效率均高于CTX冲击治疗组；但几乎所有患者初均有一过性肝功能ALT增高，给与护肝治疗后，绝大多数患者能坚持治疗、肝功能恢复正常；其他不良反应少见。结论：激素联合小剂量莱氟米特能安全有效的缓解难治性肾病；近期临床治疗缓解率高于CTX冲击治疗，远程疗效有待观察。

Effect of Low Dosage Leflunomide on Treatment of Refractory Nephrotic Syndrome

Objective： To observe the effect of small dosage of leflunomide （LEF） combined prednisone on treatment refractory ne- phrotic syndrome. Method： Sixty patients were treated with prednisone 0.8-1.0mg.kg-1.d-1 ,if there were no effect, after 2 months treatment, prednisone decreased to 30 mg, po, qd rapidly, and added LEF combined therapy （the load dosage of LEF was 20 mg.d- 1 × 3 d, the maintain dosage was 10mg.d- 1× 6 months）. The control group was used cyclophosphamide （CTX）400mg iv× 2d lashed thera- py every half month （ total CTX did not overtaken 8.0 g） and combined prednisone 30-60 mg. d - 1, at the same time. The quantity of 24 h urine protein,liver and kidney function, blood routine and ADR were observed 4,8 and 24 weekly. Result： Affter treatment of low dosage LEF,24 h urine protein was decresed and the serum albumin was increased obviously than CTX lashed group （P 〈0. 01 ）. The whole relieved rate and total effective rate were higher than that of the CTX group. Almost all patients had short-term ALT increased at the beganin of treatment, but the great major patients could persist treatment and the liver function could recover, another ADR was few. Conclusion： Low dosage of LEF combining prednisone can relief refractory nephrotic syndrome effectively and safely, the short time re- lief rate is higher than that of the CTX lashing therapy, the forward therapeutic effect await to be observed.