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目的:观察来氟米特治疗对环磷酰胺治疗无效或无法耐受的狼疮性肾炎(LN)的疗效和安全性。方法:23例经环磷酰胺治疗无效或无法耐受且均经肾穿刺活检证实的LN患者,停用环磷酰胺4周后,应用来氟米特及强的松治疗,疗程6个月;治疗期间监测有关指标并记录所有不良反应;治疗前后行疗效、狼疮活动指数(SLEDAI)及安全性评价。结果:共有22例完成治疗、1例因费用问题退出治疗。治疗2个月后开始起效、3～4个月后明显有效、6个月时各项指标仍较稳定。治疗前后SLEDAI评分明显改善,总有效率为77%。来氟米特不良反应轻,以胃肠道症状、带状疱疹、脱发多见。结论:来氟米特联合强的松用于环磷酰胺治疗无效或无法耐受的LN有较好的效果,耐受性尚好。
Objective: To observe the efficacy and safety of leflunomide in the treatment of lupus nephritis (LN) that is ineffective or intolerant to cyclophosphamide. Methods: Twenty - three patients with LN who were treated with cyclophosphamide ineffectively or intolerably and confirmed by renal biopsy were treated with leflunomide and prednisone after 4 weeks of withdrawal of cyclophosphamide. The course of treatment was 6 months. Monitor the relevant indicators during treatment and record all the adverse reactions; before and after treatment efficacy, lupus activity index (SLEDAI) and safety evaluation. Results: A total of 22 patients completed the treatment and 1 patient was withdrawn due to cost issues. Treatment started 2 months after onset, 3 to 4 months after the effective, 6 months when the indicators are still relatively stable. Before and after treatment SLEDAI score improved significantly, the total effective rate was 77%. Leflunomide adverse reactions to gastrointestinal symptoms, shingles, hair loss more common. CONCLUSION: Leflunomide combined with prednisone is superior to cyclophosphamide in the treatment of ineffective or intolerable LN with good tolerance.