曾蕾 殷彩霞 黄雷招

[摘要] 目的 研究来氟米特联合糖皮质激素对免疫球蛋白A（immunoglobulin A，IgA）肾病患者疗效的影响。 方法 选择自2011年8月～2014年9月在我院接受治疗的IgA肾病患者112例进行研究，对照组患者给予常规药物及泼尼松龙片治疗，观察组用来氟米特联合泼尼松龙片治疗，随访12个月，对比两组临床疗效、治疗前后的24 h尿蛋白水平以及用药后的不良反应。 结果 观察组的总有效率71.43%，显著高于对照组的51.79%，差异有统计学意义（P<0.05）。两组治疗后的24 h尿蛋白水平较治疗前明显降低，但观察组较对照组明显更低，差异有统计学意义（P<0.05）。观察组用药治疗后的血肌酐及胱抑素C（CYC）的水平与对照组相比，差异无统计学意义（P>0.05）。观察组用药后的不良反应总发生率8.93%，与对照组的1.79%相比，差异无统计学意义（P>0.05）。 结论 来氟米特联合糖皮质激素较单用糖皮质激素更能有效减低IgA肾病患者蛋白尿，不良反应未见增加，值得临床推广。

[关键词] 来氟米特；糖皮质激素；IgA肾病；24 h尿蛋白

[中图分类号] R692.3 [文献标识码] B [文章编号] 1673-9701（2015）34-0021-04

The influence of effect of leflunomide combined with glucocorticoid for patients with IgA glomerulonephritis

ZENG Lei YIN Caixia HUANG Leizhao

Department of Kidney Internal Medicine，Zhanjiang City Central People's Hospital of Guangdong Province， Zhanjiang 524037， China

[Abstract] Objective To study the influence of effect of leflunomide combined with glucocorticoid for patients with IgA glomerulonephritis. Methods From August 2011 to September 2014 in our hospital accepted treatment of IgA glomerulonephritis patients 112 cases as for research， the control group was given with prednisone tablets， observation group was given with leflunomide and prednisone tablets， patients were followed up for 12 months， the clinical efficacy of the two groups， before and after the treatment of the 24 h urine protein levels and medication adverse reactions were compared. Results The total effective rate of the observation group was 71.43%， which was significantly higher than the control group of 51.79%， the difference was statistically significant（P<0.05）. The levels of urinary protein in the two groups after treatment were significantly lower than before treatment， while the observation group was significantly lower than the control group（P<0.05）. The observation groups blood creatinine and cystatin C levels after treatment compared with the control group， the difference was not statistically significant（P>0.05）. The total incidence of adverse reactions in the observation group was 8.93%， compared with the control group of 1.79%， the difference was not statistically significant（P>0.05）. Conclusion The effect of leflunomide combined with glucocorticoid in the treatment of IgA glomerulonephritis can effectively reduce patients proteinuria， adverse reactions were not increased， it is worth clinical promotion.

[Key words] Leflunomide； Glucocorticoid； IgA glomerulonephritis； 24 h urine protein

慢性肾炎属于肾小球疾病，其发病形式差异较大，病情发展缓慢，主要临床症状为蛋白尿、血尿以及高血压等。IgA肾病患者的肾功能多受到一定程度损害，且呈恶化趋势，如不及时给予有效治疗，则会发展成慢性肾衰竭，严重威胁患者生命安全[1]。因为多数患者发病原因为免疫介导炎症，所以临床通常将抑制免疫以及其所介导的炎症作为主要治疗目的。临床研究表明[2]，24 h尿蛋白定量1g及以上患者，其尿蛋白能够加快IgA肾病肾小球硬化发展进程，降低尿蛋白有助于减缓患者肾功能恶化以及保护肾脏[3]。据报道[4]，免疫抑制剂与激素药物联用治疗IgA肾病，能够有效降低患者尿蛋白水平，临床疗效显著。本文……