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目的探讨来氟米特、ACEI联合治疗IgAN的疗效和安全性。方法选择肾活检确诊为IgAN的病例40例,根据随机配对法,分设治疗组、对照组,每组各20例。观察来氟米特、ACEI联合疗法降低蛋白尿的临床疗效、副反应,并与激素联合ACEI疗法进行比较;观察来氟米特、ACEI联合疗法对肾功能的影响,并比较本疗法与激素联合ACEI疗法两组间肾功能的差异;治疗1年后重复肾活检,观察本疗法对改善病理病变的程度或阻止肾小球硬化及小管间质病变的疗效。结果治疗组和对照组均能降低蛋白尿、减少尿红细胞、升高血浆白蛋白及改善肾功能,两组治疗前后的差异具有统计学意义(P<0.05),同时治疗组较对照组在改善尿蛋白及升高血浆白蛋白疗效有显著性差异(P<0.05),尤其治疗组较对照组在改善远期肾功能方面的疗效有非常显著性差异(P<0.01)。两组治疗前后病理病变程度均有所减轻,差异有统计学意义(P<0.05)。治疗组较对照组治疗后病理病变的减轻程度的差异有统计学意义(P<0.05)。结论来氟米特、ACEI联合治疗IgAN能够降低蛋白尿和减少尿红细胞,抑制肾小球系膜增生、细胞外基质产生,同时能够防止肾小球硬化的发生或发展,能够改善IgAN的远期肾功能。
Objective To investigate the efficacy and safety of leflunomide combined with ACEI in the treatment of IgAN. Methods Forty cases of IgAN confirmed by renal biopsy were divided into treatment group and control group according to random matching method, with 20 cases in each group. To observe the clinical efficacy and side effects of leflunomide and ACEI combination therapy to reduce proteinuria, and to compare with hormones and ACEI therapy; To observe the effect of leflunomide and ACEI combination therapy on renal function, and to compare the combination therapy with hormones ACEI treatment of renal function differences between the two groups; 1 year after treatment, repeat the renal biopsy, to observe the extent of this therapy to improve the pathological lesions or prevent glomerular sclerosis and tubulointerstitial lesions. Results Both the treatment group and the control group were able to reduce proteinuria, reduce urinary erythrocytes, increase plasma albumin and improve renal function, the difference between the two groups before and after treatment was statistically significant (P <0.05), while the treatment group compared with the control group improved Urine protein and plasma albumin increased significantly (P <0.05), especially in the treatment group compared with the control group in improving the long-term renal function has a very significant difference (P <0.01). The pathological changes of both groups were alleviated before and after treatment, the difference was statistically significant (P <0.05). There was significant difference between the treatment group and the control group in pathological lesion (P <0.05). Conclusions Leflunomide and ACEI combined with IgAN can reduce proteinuria and reduce urinary erythrocytes, inhibit mesangial proliferation and extracellular matrix production, prevent the occurrence or development of glomerulosclerosis, improve IgAN long-term Kidney function.