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目的观察新型免疫抑制剂来氟米特治疗狼疮肾炎(lupus nephritis,LN)的临床及病理疗效。方法对22例肾活检确诊为Ⅱb以上的LN患者,观察来氟米特治疗前后系统性红斑狼疮活动指数(SLEDAI)评分、临床和免疫指标;通过重复肾活检,观察治疗前后肾组织的病理变化,评价其对LN病理活动性的影响。结果LN患者使用来氟米特一般在用药1～2个月开始起效,3个月后明显有效,维持用药到6、9、12个月时仍能保持实验室检测指标的改善和稳定。1年后,临床SLEDAI评分明显改善,重复肾活检发现有8例发生病理转型(转型率为36.4%),由重转轻。其余病例虽未发生转型,但病理表现均稳定好转,肾脏活动性指数明显下降,无一例复发。来氟米特的副作用较小、较轻,经对症治疗均能恢复。结论来氟米特能较好地控制LN的病情活动,防止复发,且副反应少,是目前较为理想的一种治疗狼疮肾炎的新型免疫抑制剂。
Objective To observe the clinical and pathological effects of leflunomide, a novel immunosuppressive drug, on lupus nephritis (LN). Methods Twenty-two patients with LN diagnosed as renal biopsy above grade Ⅱb were enrolled in this study. The SLEDA scores, clinical and immunological indexes before and after leflunomide treatment were observed. Renal pathological changes were observed before and after treatment by repeated renal biopsy. , Evaluate its impact on LN pathological activity. Results In patients with LN, leflunomide began to be effective at 1 to 2 months after drug administration, and was effective after 3 months. The improvement and stability of laboratory tests were still maintained after 6, 9 and 12 months of maintenance. After 1 year, the clinical SLEDAI score was significantly improved. Repeated renal biopsy found that 8 cases had pathological transformation (transformation rate of 36.4%), from heavy to light. Although the remaining cases did not transition, but the pathological findings were stable, the index of renal activity decreased significantly, no case of recurrence. Leflunomide side effects smaller, less symptomatic treatment can be restored. Conclusion Leflunomide can better control the disease activity of LN and prevent relapse with less side effects. It is a new immunosuppressant that is ideal for the treatment of lupus nephritis.