摘要
目的:评价来氟米特(LEF)与环磷酰胺(CTX)分别联合泼尼松(PED)治疗成年人特发性膜性肾病(IMN)的疗效及安全性。方法:80例原发性肾病综合征患者经肾活检确诊为IMN,在诊断上排除了继发性膜性肾病,随机分两组:LEF组40例采用LEF+PED治疗,CTX组40例采用CTX+PED治疗。治疗期间及治疗前后,监测血常规、尿常规、24h尿蛋白定量、血白蛋白、血脂、肝肾功能,6个月后行疗效和安全性的评价。结果:(1)LEF组40例中失访1例,完成6个月治疗39例。CTX组40例中因不耐受药物不良反应中途退出7例,完成6个月治疗33例;(2)治疗3个月后LEF组的完全缓解率显著低于CTX组(χ2=4.3516,P<0.05),LEF组的未缓解显著高于CTX组(χ2=4.9059,P<0.05);治疗6个月后两组的完全缓解率、未缓解率差异无统计学意义(P均>0.05);(3)治疗6个月后,两组患者的24hUpro、Alb、TC、TG均较治疗前显著改善(LEF组:t=7.0841,9.0998,8.4412,7.7942;CTX组:t=8.7823,9.2826,7.1252,6.9731,P均<0.01),CTX组的改善略微优于LEF组(t=1.8112,1.6780,0.9881,1.6778,P均>0.05),但差异均无统计学意义;(4)CTX组中因不良反应中途退出的比率(7/40)显著高于LEF组(0/40),(χ2=5.6360,P<0.05);LEF组不良反应发生率(5/39)显著低于CTX组(13/40),(χ2=4.3468,P<0.05),差异均有统计学意义。结论:来氟米特治疗膜性肾病,与环磷酰胺的临床疗效相似,不良反应较少,但起效稍慢。
Objective：To evaluate the efficacy and safety of leflunomide（LEF） and cyclophosphamide（CTX） in combination with prednisone treatment of adults with idiopathic membranous nephropathy（IMN）.Methods：80 patients with primary nephrotic syndrome patients was diagnosed IMN by biopsy,excluding the diagnosis of secondary membranous nephropathy,randomly divided into two groups：LEF group of 40 patients with（LEF＋PED） treatment,CTX group of 40 patients used（CTX＋PED） therapy.During the treatment,before and after treatment,to detecte the blood and urine routine,24-hour urine protein quantity,serum albumin levels,blood fat,serum creatinine（Scr）,hepatic and renal functions,the efficacy and safety were evaluated six months later.Results：（1）In the LEF group of 40 patients,1 patient was lost,39 patients completed 6 months of treatment.In the CTX group of 40 patients,7 cases was forced to withdraw because of adverse drug reactions,33 patients completed 6 months of treatment.②The complete remission rate in the LEF group were significantly lower than the CTX group three months later.（χ2=4.351 6,P0.05）;The non-remission rate in the LEF group was significantly higher than the CTX group（χ2=4.905 9,P0.05）;The complete remission rate and the remission rate between the two groups is no significant difference in the two groups after 6 months treatment;③After 6 months therapy,24 h Upro,Alb,TC,TG in the both groups were significantly improved than that before treatment（the LEF group：t=7.084 1,9.099 8,8.441 2,7.794 2;the CTX group：t=8.782 3,9.282 6,7.125 2,6.973 1,P all0.01）,the CTX group to improve was slightly superior to the LEF group（t=1.811 2,1.678 0,0.988 1,1.677 8,P all〉0.05）,but there was no significant difference between the two groups;（4）The exit rate due to adverse events in the CTX group（7/40）was significantly higher than that in the LEF group（0/40）,（④χ2 ④=5.636 0,④P ④〈0.05）,The incidence of adverse reactions in the LEF group（5/39） was s
出处
《中国中西医结合肾病杂志》
2011年第10期872-874,共3页
Chinese Journal of Integrated Traditional and Western Nephrology
关键词
肾病综合征
特发性膜性肾病
来氟米特
环磷酰胺
泼尼松
Nephrotic syndrome Idiopathic membranous nephropathy Leflunomide Cyclophosphamide Prednisone
