来氟米特及雷公藤多苷治疗IgA肾病对照探究.docVIP

来氟米特及雷公藤多苷治疗IgA肾病对照探究【摘要】 目的 观察来氟米特(LEF)、雷公藤多苷联合激素治疗IgA肾病的疗效和安全性。方法 收集符合条件的60例中等量蛋白尿IgA肾病患者随机分为2组，试验组LEF联合中等量激素治疗，对照组雷公藤多苷联合中等量激素治疗，观察治疗前、后1、3、6个月的相关临床指标变化，并进行评价。结果 试验组治疗后24 h尿蛋白定量显著减少(P0.05)。观察组起效快，不良反应轻微，患者耐受性好。结论 来氟米特联合激素可以作为治疗IgA肾病的选择之一，且安全、有效。? 【关键词】 来氟米特；IgA肾病；雷公藤多苷 ?? Control study Lefunomide and triptolide in treating IgA nephropathy CHANG Jing, ZHANG Wen?juan, SONG Xiu?qin, et al. Department of Nephrology, Yantai Hill Hospital,Yantai 264000, China ? 【Abstract】 Objective To investigate the infects and safety of Lefunomide(LEF) combined with medium dose glucocorticoid,and Triptolide with medium dose glucocorticoid for IgA nephropathy with medium albuminuria. Methods Sixty patients with IgA nephropathy with medium albuminuria were devided into two groups at random.The patients in test group were treated with LEF combined with medium dose glucocorticoid.The patients in control group received Triptolide with medium dose glucocorticoid. Clinical data were observed and evaluated in months 1,3 and 6 during the treatment. Results After receiving LEF therapy,the proteinuria in the test group decreased siganificantly (P0.05). LEF can act more quickly than triptolide,the side effects were mild and all patients tolerated this therapy. Conclusion LEF combined with medium dose glucocorticoid therapy can be one of the safety and effective choices for treatment of IgA nephropathy.? 【Key words】 Lefunomide; IgA nephropathy; Triptolide ? ? 作者单位：264000烟台市烟台山医院肾内科 IgA肾病是我国慢性肾小球肾炎最常见的病理类型之一，约占39.15%［1］。目前认为IgA肾病是一种进展性疾病，明确诊断后每10年约有20%的患者进展至终末期肾病［2］，目前国内外尚无统一有效的方案。比较一致的看法是IgA肾病是一种免疫复合物性肾炎［3］。来氟米特(luflunomide，LEF)作为一种新型免疫抑制剂，能抑制免疫反应的多个阶段而发挥其治疗作用。本研究观察LEF、雷公藤多苷联合激素治疗中等量蛋白尿IgA肾病的疗效和安全性，报告如下。? 1 资料与方法? 1.1 一般资料 选择2002年1月至2009年1月在本院符合原发性IgA肾病诊断标准的患者共60例，按随机数字表分为实验组和对照组。肾活检Lee氏分级为Ⅱ~Ⅳ级，且为持续性中等量蛋白尿(1~3 g/d)，血清肌酐(SCr0.05)，排除继发性IgA肾病及其他系统慢性疾病史。? 1.2 方法及观察指标实验组：口服LEF(苏州长征?欣凯制药厂生产)的起始剂量为30 mg/d顿服,服药3 d后减量为20 mg/d顿服，连续服用6个月；激素用量为口服强的松的起始