口服爱若华联合甲基强的松龙肾囊注射治疗原发性局灶节段性肾小球硬化9例报告

目的探讨新型免疫抑制剂来氟米特(商品名:爱若华)和肾囊注射甲基强的松龙联合治疗局灶节段性肾小球硬化症(FSGS)的疗效和安全性。方法从我院2002年前经肾活检患者中确诊为FSGS的16例患者中随机选取10例(均采用常规类固醇口服治疗)患者作为对照组,从2002年始所有肾穿刺确诊为FSGS的9例患者作为治疗组,采用口服爱若华,同时肾囊注射甲基强的松龙长期治疗1年。在治疗前及治疗6个月、1年后观察24h尿蛋白定量、血尿素(Urea)、血肌酐(Scr)、内生肌酐清除率(Ccr)等指标变化,按照疗效评定标准对比分析联合治疗实验组与常规治疗对照组的疗效和安全性。结果联合治疗组显著降低24h尿蛋白定量,其中治疗6个月蛋白尿完全缓解率为34.5%、部分缓解率为44.5%,明显高于对照组(17.5%、25.4%)(P<0.01);12个月完全缓解率累加为67%(对照组:29.8%),部分缓解率累加为21.3%(对照组:38.5%)(P<0.01)。疗程中未发现糖皮质激素的副作用,有2例发现一过性来氟米特致肝酶升高,减量和对症治疗后恢复正常。结论爱若华联合肾囊注射甲基强的松龙治疗FSGS较常规治疗有效,副作用少,值得进一步研究与观察。

Treatment of focal segmental glomerulosclerosis by leflunomide and Methylprednisolone injected into renal capsule:A report of 9 cases

Objective To investigate the effect and security of.Methods From 16 FSGS patients who were diagnosed by renal biopsy in our hospital before 2002,10 patients were selected randomly as control group,and received treatment with routine method(oral steroid).9 FSGS patients who were diagnosed by renal biopsy in our hospital since 2002 were selected as test group,and were treated with oral leflunomide and MP by Intra-renal-capsular(irc)injection.All the patients were treated for 1 year.Teh change of markers such as quantity of urinary protein for 24h、and surum urea(Urea)、serum creatinine(SCr)、CCr before and after treatment for 6 months and 1 year was analyzed.The effect and security of the two groups were compared and analyzed according to the standard of effect evaluation.Results The 24h urinary protein excretion decreased significantly in test group,the complete remission rate in test group after 6 months was 34.5% and partial remissioin rate was 44.5%,obviously greater than those in the control group(17.5%、25.4%)(P<0.01).In test group the complete remission rate after 12 months was 67%(29.8% in control group) and partial remission rate was 21.3%(18.5% in control).There also was a very significant difference between test group and control group,P<0.01.In test group there was no adverse reaction of MP,and 2 patients'ALT increased temporarily induced by Leflunomide,but recovered to the normal after reducing the drug and allopathy.Conclusion The combination of Leflunomide and MP injected into the renal capsule is obviously superior to routine medicines in the treatment of FSGS.Since the method can offer a better effect and lower adverse reaction it worth being observed and researched in clinic.