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目的:观察来氟米特(LEF)联合甲泼尼龙(MP)治疗重症活动性狼疮肾炎(LN)的疗效及安全性。方法:应用LEF联合MP治疗32例重症活动性LN患者,肾活检病理类型为Ⅳ或V型,系统性红斑狼疮疾病活动指数(SLEDAI)≥8。对比观察治疗前和治疗后1,3,6个月的24 h尿蛋白、肾功能、血浆白蛋白、抗核杭体、抗ds-DNA,补体C3水平的变化,并记录不良反应。结果:治疗3个月时总有效率74.9%,治疗6个月后总有效率上升到90.6%。治疗前后比较:患者24 h尿蛋白、肾功能、血浆白蛋白、抗核杭体、抗ds-DNA、补体C3指标均明显改善(P<0.05),且随着治疗时间延长,各项指标改善愈明显。治疗过程中3例出现胃肠道反应,2例出现一过性白细胞下降,未发生严重不良反应。结论:LEF联合MP治疗重症活动性LN疗效显著,不良反应轻,耐受性良好,值得临床推广使用。
Objective: To observe the efficacy and safety of leflunomide (LEF) and methylprednisolone (MP) in the treatment of severe active lupus nephritis (LN). Methods: Thirty-two patients with severe active LN were treated with LEF combined with MP. The pathological type of renal biopsy was type IV or V, and the disease activity index (SLEDAI) of systemic lupus erythematosus was ≥8. The changes of 24 h urinary protein, renal function, serum albumin, anti-nuclear antigen, anti-dsDNA and complement C3 were observed before treatment and 1, 3 and 6 months after treatment. Adverse reactions were recorded. Results: At 3 months, the total effective rate was 74.9%. After 6 months, the total effective rate increased to 90.6%. Before and after treatment, urinary protein, renal function, serum albumin, anti-nuclear anti-dsDNA and complement C3 were significantly improved in 24 h patients (P <0.05), and with the prolongation of treatment time, the indexes improved The more obvious. In the course of treatment, gastrointestinal reactions occurred in 3 cases and transient leukocytosis in 2 cases. No serious adverse reactions occurred. Conclusion: LEF combined with MP has significant curative effect on severe active LN with mild adverse reactions and good tolerability, which is worthy of clinical application.