[1]张连云,朱铁锤,郭明好.来氟米特联合厄贝沙坦治疗狼疮性肾炎疗效观察[J].新乡医学院学报,2017,34(6):496-499.[doi:10.7683/xxyxyxb.2017.06.011]
 ZHANG Lian-yun,ZHU Tie-chui,GUO Ming-hao.Effect of leflunomide combined with irbesartan for treating lupus nephritis[J].Journal of Xinxiang Medical University,2017,34(6):496-499.[doi:10.7683/xxyxyxb.2017.06.011]
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来氟米特联合厄贝沙坦治疗狼疮性肾炎疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年6
页码:
496-499
栏目:
临床研究
出版日期:
2017-06-05

文章信息/Info

Title:
Effect of leflunomide combined with irbesartan for treating lupus nephritis
作者:
张连云1朱铁锤1郭明好2
(1.新乡医学院第一附属医院肾病风湿免疫二科,河南 新乡 453100;2.新乡医学院第三附属医院肾病风湿免疫科,河南 新乡 453003)
Author(s):
ZHANG Lian-yun1ZHU Tie-chui1GUO Ming-hao2
(1.Department of Nephrology and Rheumatology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan Province,China;2.Department of Nephrology and Rheumatology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)
关键词:
来氟米特狼疮性肾炎厄贝沙坦
Keywords:
leflunomidelupus nephritisirbesartan
分类号:
R593.24+2
DOI:
10.7683/xxyxyxb.2017.06.011
文献标志码:
A
摘要:
目的 探讨来氟米特联合厄贝沙坦治疗狼疮性肾炎的临床效果。方法 选取新乡医学院第一附属医院2013年3月至2016年3月收治的狼疮性肾炎患者88例,按照入院顺序分为对照组和观察组,每组44例。2组患者均采用标准激素治疗联合厄贝沙坦治疗,在此基础上,对照组患者口服环磷酰胺片 3 mg·kg-1·d-1,观察组患者口服来氟米特片,前3 d剂量为50 mg·d-1,3 d后减少为20 mg·d-1,2组患者均治疗6个月。比较2组患者治疗3、6个月后肾功能和血液学指标的变化及其疗效。结果 治疗前2组患者24 h蛋白尿、尿β2-微球蛋白(β2-MG)、尿红细胞计数比较差异均无统计学意义(P>0.05)。2组患者治疗3、6个月时的24 h蛋白尿、尿β2-MG、尿红细胞计数均低于治疗前(P<0.05);治疗6个月时2组患者的24 h蛋白尿、尿β2-MG、尿红细胞计数均低于治疗3个月(P<0.05)。观察组患者治疗3、6个月时的24 h蛋白尿、尿β2-MG、尿红细胞计数均低于对照组(P<0.05)。2组患者治疗前血白蛋白、红细胞沉降率(ESR)、血β2-MG、血肌酐(Cr)、C反应蛋白(CRP)及补体C3水平比较差异均无统计学意义(P>0.05)。2组患者治疗3、6个月时的血白蛋白水平高于治疗前,ESR、血β2-MG、血Cr、CRP及补体C3水平低于治疗前(P<0.05);观察组患者治疗6个月时的血白蛋白水平高于治疗3个月,ESR、血β2-MG、血Cr、CRP及补体C3水平低于治疗3个月(P<0.05);对照组患者治疗6个月时血白蛋白、ESR及β2-MG水平与治疗3个月时比较差异无统计学意义(P>0.05),血Cr、CRP及补体C3水平低于治疗3个月时(P<0.05)。观察组患者治疗3、6个月时血白蛋白的水平高于对照组,ESR、血β2-MG、血Cr、CRP、补体C3水平低于对照组(P<0.05)。观察组患者治疗3、6个月时的缓解有效率分别为84.09%(37/44)、90.91%(40/44),对照组患者治疗3、6个月的缓解有效率分别为72.73%(32/44)、81.82%(36/44),观察组患者治疗3、6个月的缓解有效率均高于对照组(χ2=10.218,P<0.05)。观察组和对照组患者不良反应发生率分别为6.82%(3/44)、15.91%(7/44),观察组患者不良反应发生率显著低于对照组(χ2=11.210,P<0.05)。结论 来氟米特联合厄贝沙坦治疗狼疮性肾炎的疗效优于环磷酰胺联合厄贝沙坦,且血液指标恢复明显,不良反应发生率低。
Abstract:
Objective To explore the clinical efficacy of leflunomide combined with irbesartan for treating lupus nephritis.Methods Eighty-eight patients with lupus nephritis were selected in the First Affiliated Hospital of Xinxiang Medical University from March 2013 to March 2016.The patients were divided into control group and observation group according to the admission order,with 44 patients in each group.All patients were given standard hormone therapy and irbesartan.Based on this,the patients in the control group were treated with cyclophosphamide tablet(3 mg·kg-1·d-1);the patients in observation group were given leflunomide tablets 50 mg·d-1 for the first 3 days,the dose reduced to 20 mg·d-1 after 3 days.All patients were treated for 6 months.The clinical efficacy,changes of renal function and hematology indexes of patients at 3,6 months after treatment were compared between the two groups.Results There was no significant difference in the 24 h proteinuria,urine β2-microglobulin(β2-MG),urine red blood cell count of patients between the two groups before treatment(P>0.05).The levels of 24 h proteinuria,urine β2-MG and urine red blood cell count of patients in the control group and observation group at 3,6 months after treatment were significantly lower than those before treatment(P<0.05);the levels of 24 h proteinuria,urine β2-MG and urine red blood cell count of patients in the two groups at 6 months after treatment were significantly lower than those at 3 months(P<0.05).The levels of 24 h proteinuria,urine β2-MG and urine red blood cell count of patients in the observation group at 3,6 months after treatment were significantly lower than those in the control group(P<0.05).There was no significant difference in the erythrocyte sedimentation rate(ESR) and the levels of albumin,β2-MG,creatinine(Cr),C-reactive protein(CRP),complement C3 in serum of patients between the two groups before treatment(P>0.05).The levels of blood albumin of patients in the control group and observation group at 3,6 months after treatment were significantly higher than those before treatment(P<0.05);while the ESR and the levels of β2-MG,Cr,CRP,complement C3 in serum were significantly lower than those before treatment(P<0.05).The level of blood albumin of patients in the observation group at 6 months after treatment were significantly higher than those at 3 months after treatment(P<0.05);the levels of ESR,β2-MG,Cr,CRP and complement C3 in serum of patients in the observation group at 6 months after treatment were significantly lower than that at 3 months after treatment(P<0.05).In the control group,there was no statistic difference in the levels of blood albumin,β2-MG and ESR of patients at 6 months and 3 months after treatment(P>0.05);the levels of Cr,CRP and complement C3 in serum of patients at 6 months after treatment were significantly lower than those at 3 months after treatment(P<0.05).The levels of blood albumin of patients in the observation group at 3,6 months after treatment were significantly higher than those in the control group(P<0.05);while the ESR and the levels of β2-MG,Cr,CRP,complement C3 in serum were significantly lower than those in the control group(P<0.05).In the observation group,the remission rate of patients at 3 months and 6 months after treatment was 84.09%(37/44) and 90.91%(40/44) respectively;in the control group,the remission rate of patients at 3 months and 6 months after treatment was 72.73%(32/44) and 81.82%(36/44) respectively.The remission rates of patients at 3 months and 6 months after treatment in the observation group were significantly higher than those in the control group(χ2=10.218,P<0.05).The incidence of adverse reaction in the observation group and control group was 6.82%(3/44) and 15.91%(7/44) respectively,the incidence of adverse reaction in the observation group was significantly lower than that in the control group(χ2=11.210,P<0.05).Conclusion Leflunomide combined with irbesartan for treatment of lupus nephritis has better efficacy than cyclophosphamide combined with irbesartan;and the recovery of blood index is obvious,the incidence of adverse reactions is low.

参考文献/References:

[1] 宋红梅,李冀.狼疮性肾炎诊疗建议介绍[J].中华实用儿科临床杂志,2014,29(5):326-330.
[2] HU W X,CHEN Y H,BAO H,et al.Glucocorticoid with or without additional immunosuppressant therapy for patients with lupus podocytopathy:a retrospective single-center study[J].Lupus,2015,24(10):1067-1075.
[3] CAO H,RAO Y,LIU L,et al.The efficacy and safety of leflunomide for the treatment of lupus nephritis in Chinese patients:systematic review and meta-analysis[J].PLoS One,2015,10(12):e144548.
[4] PONTICELLI C,MORONI G.Immunosuppression in pregnant women with systemic lupus erythematosus[J].Expert Rev Clin Immunol,2015,11(5):549-552.
[5] FURIE R,TODER K,ZAPANTIS E.Lessons learned from the clinical trials of novel biologics and small molecules in lupus nephritis[J].Semin Nephrol,2015,35(5):509-520.
[6] KURASAWA T,NAGASAWA H,NISHI E,et al.Successful treatment of class IV+V lupus nephritis with combination therapy of high-dose corticosteroids,tacrolimus and intravenous cyclophosphamide[J].Intern Med,2013,52(10):1125-1130.
[7] WANG H Y,CUI T G,HOU F F,et al.Induction treatment of proliferative lupus nephritis with leflunomide combined with prednisone:a prospective multi-centre observational study[J].Lupus,2008,17(7):638-644.
[8] ZHANG F S,NIE Y K,JIN X M,et al.The efficacy and safety of leflunomide therapy in lupus nephritis by repeat kidney biopsy[J].Rheumatol Int,2009,29(11):1331-1335.
[9] 何庆南.狼疮性肾炎的诊断与治疗[J].实用儿科临床杂志,2011,26(9):640-642.
[10] 祝兴年.来氟米特联合厄贝沙坦治疗狼疮性肾炎37例临床效果观察[J].内科,2015,10(4):477-478.
[11] 郭玉芹,赵卫红.来氟米特联合厄贝沙坦治疗狼疮性肾炎的疗效观察[J].现代药物与临床,2014,29(11):1266-1269.
[12] 夏宇欧.来氟米特联合泼尼松治疗狼疮性肾炎的临床疗效研究[J].医学综述,2012,18(3):465-467.
[13] 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.

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更新日期/Last Update: 2017-06-05