论文部分内容阅读
目的比较来氟米特与环磷酰胺治疗难治性肾病综合征(refractory nephrotic syndrome,RNS)的效果,为临床提供治疗参考方案。方法选取2011年12月—2014年1月治疗的98例对激素抵抗或激素依赖的肾病综合征(nephrotic syndrome,NS)患者,随机分为来氟米特组(LEF组)和环磷酰胺组(CTX组)两组,LEF组53例,CTX组45例,在使用糖皮质激素治疗(口服泼尼松1 mg·kg-1·d-1)的基础上,LEF组加用来氟米特治疗,来氟米特负荷量50 mg/d,3 d后改为20 mg/d,达到疗效3~6个月后减为10mg/d,CTX组加用环磷酰胺治疗,每月静滴环磷酰胺冲击一次,(0.8~1.0)g/次,持续用药6个月后改为2~3月一次,总用药量为8~10g,两组免疫抑制剂用药总时间为一年,观察两组的疗效和不良反应并作出统计分析。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果随访结束时,LEF组较CTX组血浆白蛋白明显升高[(39.58±6.58)、(35.96±7.22)g/L],24 h尿蛋白定量降低[(0.71±1.21)、(1.77±2.28)g],差异均有统计学意义(均P<0.05)。LEF组的总有效率为98.1%,完全缓解率为60.4%,高于CTX组的84.4%、40%,差异均有统计学意义(均P<0.05)。LEF组的不良反应发生率为11.3%,低于CTX组的24.4%,差异无统计学意义(P>0.05)。结论来氟米特治疗RNS比环磷酰胺更具有优势,但仍需要更多的循证依据支持。
Objective To compare the efficacy of leflunomide and cyclophosphamide in the treatment of refractory nephrotic syndrome (RNS) and provide a reference for clinical treatment. Methods A total of 98 patients with steroid-resistant or hormone-dependent nephrotic syndrome (NS) who were treated from December 2011 to January 2014 were randomly divided into leflunomide group (LEF group) and cyclophosphamide group (CTX group), 53 cases in LEF group and 45 cases in CTX group. On the basis of glucocorticoid treatment (oral prednisone 1 mg · kg -1 · d-1) Treatment, leflunomide load 50 mg / d, 3 d after the change to 20 mg / d, to 3 to 6 months after treatment to reduce the 10mg / d, CTX group with cyclophosphamide treatment, monthly static Drops of cyclophosphamide once, (0.8 ~ 1.0) g / time, continuous medication 6 months later changed to 2 to 3 months, the total dose of 8 ~ 10g, immunosuppressive drugs in both groups for a total time of one year, The efficacy and adverse reactions of the two groups were observed and statistically analyzed. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results At the end of follow-up, serum albumin in LEF group was significantly higher than that in CTX group [(39.58 ± 6.58), (35.96 ± 7.22) g / L], and 24 h urinary protein [(0.71 ± 1.21), (1.77 ± 2.28 ) g], the differences were statistically significant (all P <0.05). The total effective rate was 98.1% in the LEF group, the complete remission rate was 60.4%, higher than 84.4% and 40% in the CTX group (all P <0.05). The incidence of adverse reactions in the LEF group was 11.3%, which was lower than that in the CTX group (24.4%), with no significant difference (P> 0.05). Conclusions Leflunomide is more advantageous than cyclophosphamide in the treatment of RNS, but more evidence-based support is still needed.