来氟米特治疗狼疮性肾炎的临床疗效与安全性
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摘要
目的观察新型免疫抑制剂来氟米特治疗狼疮性肾炎(LN)的临床疗效。方法选取我科2011年1月~2014年1月经肾穿刺病理活检证实为LN的患者40例,随机分为实验组和对照组各20例,实验组予来氟米特治疗,对照组予静脉滴注环磷酰胺治疗。对比两组患者治疗前后的24小时尿蛋白、血肌酐、血白蛋白、补体水平、ANA、ds-DNA、系统性红斑狼疮活动指数(SLEDAI)和病理肾组织活动性指数(AI)、慢性指数(CI);对比两组患者治疗3个月后的临床疗效。结果两组患者治疗1、3个月后的24小时尿蛋白、血肌酐显著低于前一时间点,血白蛋白、C3、C4水平显著高于前一时间点(均P<0.05);实验组治疗1、3个月后的24小时尿蛋白、血肌酐显著低于同期对照组,血白蛋白、C3、C4水平显著高于同期对照组(均P<0.05)。两组患者治疗1、3个月后的ANA、ds-DNA和SLEDAI及AI、CI均显著低于治疗前(均P<0.05);实验组治疗1、3个月后的ANA、ds-DNA和SLEDAI及AI、CI均显著低于对照组(均P<0.05),显示实验组的临床疗效显著优于对照组(χ2=3.9683,P=0.0464<0.05)。结论来氟米特治疗狼疮性肾炎相比于传统的环磷酰胺治疗,可有效控制疾病的活动性,同时不良反应较少,值得临床推广使用。
Objective To observe the clinical and pathological efficacy in new immunosuppressant leflunomide for lupus nephritis(LN).Methods 40 patients with LN with kidney puncture biopsy confirmed were randomly divided into experimental and control groups.The experimental group was given leflunomide treatment and control group received intravenous cyclophosphamide.24 hours urine protein,serum creatinine,serum albumin,complement levels,ANA,ds-DNA,systemic lupus erythematosus activity index(SLEDAI)and renal tissue pathology activity index(AI),chronic Index(CI)were compared before and after comparison in two groups of patients.The clinical efficacy after three months in the two groups of patients was also compared.Results The 24-hour urine protein serum creatinine one and three months later in two groups of patients were significantly lower than the previous time,serum albumin,C3,C4 levels were significantly higher than the previous time(P<0.05).The 24 hours urine protein and serum creatinine in the experimental group one month,three months later was significantly lower than the same period in the control group,serum albumin,C3,C4 levels were significantly higher than the control group(P<0.05).ANA and ds-DNA in two groups of patients one month,three months later was significantly lower than before treatment.SLEDAI and pathological AI,CI 3months later,was significantly lower than before treatment(P<0.05).ANA and ds-DNA in the experimental group one month,three months later was significantly lower than the control group.SLEDAI and pathological AI,CI 3months later,was significantly lower than the control group(P<0.05).The clinical efficacy of the experimental group was significantly better than the control group(χ2=3.9683,P=0.0464<0.05).Conclusion Compared to traditional cyclophosphamide treatment,leflunomide treatment for lupus nephritis can effectively control the disease activity,with fewer adverse reactions,which is worthy of widespread use.
Objective To observe the clinical and pathological efficacy in new immunosuppressant leflunomide for lupus nephritis(LN).Methods 40 patients with LN with kidney puncture biopsy confirmed were randomly divided into experimental and control groups.The experimental group was given leflunomide treatment and control group received intravenous cyclophosphamide.24 hours urine protein,serum creatinine,serum albumin,complement levels,ANA,ds-DNA,systemic lupus erythematosus activity index(SLEDAI)and renal tissue pathology activity index(AI),chronic Index(CI)were compared before and after comparison in two groups of patients.The clinical efficacy after three months in the two groups of patients was also compared.Results The 24-hour urine protein serum creatinine one and three months later in two groups of patients were significantly lower than the previous time,serum albumin,C3,C4 levels were significantly higher than the previous time(P<0.05).The 24 hours urine protein and serum creatinine in the experimental group one month,three months later was significantly lower than the same period in the control group,serum albumin,C3,C4 levels were significantly higher than the control group(P<0.05).ANA and ds-DNA in two groups of patients one month,three months later was significantly lower than before treatment.SLEDAI and pathological AI,CI 3months later,was significantly lower than before treatment(P<0.05).ANA and ds-DNA in the experimental group one month,three months later was significantly lower than the control group.SLEDAI and pathological AI,CI 3months later,was significantly lower than the control group(P<0.05).The clinical efficacy of the experimental group was significantly better than the control group(χ2=3.9683,P=0.0464<0.05).Conclusion Compared to traditional cyclophosphamide treatment,leflunomide treatment for lupus nephritis can effectively control the disease activity,with fewer adverse reactions,which is worthy of widespread use.
引文
[1]梁继红,朱春玲,陈佳.60例狼疮性肾炎的临床与病理[J].贵阳医学院学报,2011,13(04):366-370,374.
[2]李同川,贾西燕,韩爱茹,等.激素联合来氟米特治疗儿童狼疮性肾炎临床疗效观察[J].陕西医学杂志,2013,42(07):893-894.
[3]朱勇.来氟米特治疗狼疮性肾炎临床分析[J].河北医药,2013,35(12):1815-1816.
[4]李耀武,李江.来氟米特与吗替麦考酚酯治疗儿童难治性肾病综合征疗效比较[J].重庆医学,2011,40(09):867-868.
[5]张冰,李璐,湛若愚.来氟米特与霉酚酸酯治疗狼疮肾炎患者的临床疗效比较[J].临床肾脏病杂志,2013,13(07):318-321.
[6]胡小平,刘瑞菡,陈杰.检测补体C3、C4及C1q水平对狼疮性肾炎活动性判定的价值[J].贵阳医学院学报,2014,39(02):191-193.
[7]任琪,曾华松.来氟米特治疗狼疮性肾炎疗效和安全性的Meta分析[J].中国循证儿科杂志,2011,06(02):104-109.
[8]刘慧敏,张瑞英,史素芳,等.来氟米特治疗狼疮性肾炎的Meta分析[J].中国皮肤性病学杂志,2011,25(01):6-8.
[9]彭小平.来氟米特联合泼尼松治疗狼疮性肾炎42例临床分析[J].海南医学,2011,22(13):44-45.
[10]李大军,李云霞,车航.来氟米特联合吗替麦考酚酯治疗狼疮性肾炎的疗效观察[J].中华临床医师杂志(电子版),2014,01(05):853-857.
[11]邹晋梅,杨静,刘毅.系统性红斑狼疮感染状况及死亡原因分析[J].西部医学,2011,23(02):356-358.
[12]任琪,曾华松.来氟米特治疗狼疮性肾炎疗效和安全性的Meta分析[J].中国循证儿科杂志,2011,06(02):104-109.
[13]曾艳.来氟米特在肾脏疾病中的应用进展[J].南昌大学学报(医学版),2012,52(02):85-89.
[14]袁正洲,李作孝,马勋泰.来氟米特对实验性变态反应性脑脊髓炎小鼠T细胞亚群及Th1型细胞因子的影响[J].西部医学,2014,26(01):19-22.
[15]吕鸿,刘月侠,徐扬.激素联合来氟米特、环磷酰胺治疗狼疮肾炎疗效观察[J].河北医药,2014,01(10):1540-1541.
[2]李同川,贾西燕,韩爱茹,等.激素联合来氟米特治疗儿童狼疮性肾炎临床疗效观察[J].陕西医学杂志,2013,42(07):893-894.
[3]朱勇.来氟米特治疗狼疮性肾炎临床分析[J].河北医药,2013,35(12):1815-1816.
[4]李耀武,李江.来氟米特与吗替麦考酚酯治疗儿童难治性肾病综合征疗效比较[J].重庆医学,2011,40(09):867-868.
[5]张冰,李璐,湛若愚.来氟米特与霉酚酸酯治疗狼疮肾炎患者的临床疗效比较[J].临床肾脏病杂志,2013,13(07):318-321.
[6]胡小平,刘瑞菡,陈杰.检测补体C3、C4及C1q水平对狼疮性肾炎活动性判定的价值[J].贵阳医学院学报,2014,39(02):191-193.
[7]任琪,曾华松.来氟米特治疗狼疮性肾炎疗效和安全性的Meta分析[J].中国循证儿科杂志,2011,06(02):104-109.
[8]刘慧敏,张瑞英,史素芳,等.来氟米特治疗狼疮性肾炎的Meta分析[J].中国皮肤性病学杂志,2011,25(01):6-8.
[9]彭小平.来氟米特联合泼尼松治疗狼疮性肾炎42例临床分析[J].海南医学,2011,22(13):44-45.
[10]李大军,李云霞,车航.来氟米特联合吗替麦考酚酯治疗狼疮性肾炎的疗效观察[J].中华临床医师杂志(电子版),2014,01(05):853-857.
[11]邹晋梅,杨静,刘毅.系统性红斑狼疮感染状况及死亡原因分析[J].西部医学,2011,23(02):356-358.
[12]任琪,曾华松.来氟米特治疗狼疮性肾炎疗效和安全性的Meta分析[J].中国循证儿科杂志,2011,06(02):104-109.
[13]曾艳.来氟米特在肾脏疾病中的应用进展[J].南昌大学学报(医学版),2012,52(02):85-89.
[14]袁正洲,李作孝,马勋泰.来氟米特对实验性变态反应性脑脊髓炎小鼠T细胞亚群及Th1型细胞因子的影响[J].西部医学,2014,26(01):19-22.
[15]吕鸿,刘月侠,徐扬.激素联合来氟米特、环磷酰胺治疗狼疮肾炎疗效观察[J].河北医药,2014,01(10):1540-1541.