来氟米特与霉酚酸酯治疗狼疮肾炎患者的临床疗效比较

目的探讨来氟米特与霉酚酸酯治疗狼疮肾炎的临床疗效和安全性。方法选择我科40例狼疮肾炎患者随机分为2组,即来氟米特组（A组）和霉酚酸酯组（B组）,每组20例。2组均联合泼尼松治疗。对比观察2组治疗前和治疗后第3、6个月的系统性红斑狼疮疾病活动性指数（sys—temic lupus erythematosus disease activity index,SLEDAI）评分、24h尿蛋白定量、血白蛋白、血红蛋白、肾小球过滤率（eGFR）、补体C3、抗双链DNA抗体（ds-DNA）、血沉水平的变化及临床疗效,并分别记录不良反应。结果与治疗前相比,来氟米特组和霉酚酸酯组血白蛋白、血红蛋白均明显升高,24h尿蛋白定量明显降低,滤过率水平明显上升,血沉水平及ds—DNA水平明显下降,补体c3水平明显升高,能够改善肾功能及免疫指标,且2组间差异无统计学意义（P〉0．05）。来氟米特组恶心呕吐、肝功能损害、白细胞数降低、皮疹、腹泻、月经不调、高血压、感染等不良反应发生率分别为15％（3例）、20％（4例）、10％（2例）、10％（2例）、5％（1例）、15％（3例）,5％（1例）,5％（1例）;霉酚酸酯组恶心呕吐、肝功能损害、白细胞数降低、皮疹、腹泻、月经不调、高血压、感染等不良反应发生率分别为10％（占2例）、5％（1例）、0例、5％（占1例）、5％（占1例）、0例、0例、5％（占1例）。结论来氟米特和霉酚酸酯均能有效控制狼疮肾炎,但霉酚酸酯不良反应相对较轻。

Clinical efficacy comparison of leflunomide vs.mycophenolate mofetil for lupus nephritis

Objective To compare the therapeutic effectiveness and safety of leflunomide vs. mycophenolate mofetil for lupus nephritis （LN）. Methods Forty patients with reactive LN were ran- domly divided into two groups.. 20 cases in lefunomide group and 20 cases in mycophenolate mofetil group. Both two groups were given prednisone for treatment of LN. The effectiveness was observed by monitoring the changes in the accumulate points of systemic lupus erythematosus disease activity index （SLEDAI）,24-h urine protein, plasma albumin, hemoglobin, serum creatinine, complement （;3 and anti-double-stranded DNA. Erythrocyte sedimentation rate and therapeutic effectiveness before and 3 months and 6 months after treatment were analyzed. The adverse reactions were recorded. Results As compared with those before treatment, the level of plasma albumin and hemoglobin in two groups sig- nificantly increased, the 24 hour urine protein Significantly reduced, the glomerular filtration rate sig- nificantly increased, the erythrocyte sedimentation rate and the anti-double-stranded DNA significantly reduced,and the complement （23 significantly increased. They can improve the renal function and the tingnune parameters. And The difierence was not statistically significant （P~0. 05）. The rate of ad- verse reactions（disgusting vomit, liver function harm, white blood cell reduction, skin rash, abnormal menstruation, hypertension and Infection） of leflunomide group[ 15 %（3 cases）, 20 % （4 cases）,10 % （ 2 cases） ,5%（1 case） ,5%（1 case） ,15%（3 case） ,5%（1 cases）, 5%（1 cases）. The CTX group[10% （2 cases） ,5%（1 cases） ,0. 0%（0 cases） ,5%（1 cases） ,5%（1 cases） ,0. 0%（0 cases） ,0%（0 cases）, 5% （1 cases）]. Conclusions Leflunomide had the same efficacy as mycophenolate mofetil in the LN thera-py, but the side effects of leflunomide were severer than mycophenolate mofetil.