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目的:观察小剂量莱氟米特联合泼尼松治疗无效和复发的难治性肾病综合征的疗效和安全性。方法:60例患者用泼尼松0.8～1.0 mg·kg~(-1)·d~(-1)治疗2个月无效后加用莱氟米特联合治疗(负荷剂量20 mg·d~(-1)×3 d,维持量10 mg·d~(-1)×6月)。将泼尼松剂量迅速减至30 mg·d~(-1)。对照组用环磷酰胺(CTX)400 mg,iv×2 d冲击治疗每半月1次(总剂量不超过8.0g),同时联合应用泼尼松30～60 mg·d~(-1)治疗。观察4、8、24周的24 h尿蛋白定量、肝肾功能、血常规及不良反应。结果:小剂量莱氟米特治疗后24 h尿蛋白下降、血清白蛋白上升均高于CTX冲击治疗组(P<0.01),肾功能变化不大。完全缓解率及总有效率均高于CTX冲击治疗组;但几乎所有患者初均有一过性肝功能ALT增高,给与护肝治疗后,绝大多数患者能坚持治疗、肝功能恢复正常;其他不良反应少见。结论:激素联合小剂量莱氟米特能安全有效的缓解难治性肾病;近期临床治疗缓解率高于CTX冲击治疗,远程疗效有待观察。
Objective: To observe the efficacy and safety of low-dose leflunomide combined with prednisone in the treatment of refractory and recurrent refractory nephrotic syndrome. Methods: Sixty patients were treated with leflunomide (20 mg · d ~ (-1)) for 2 months after treatment with prednisone 0.8 ~ 1.0 mg · kg -1 · d -1 -1) × 3 d, the maintenance dose of 10 mg · d -1 (× 6 months)). The dose of prednisone was rapidly reduced to 30 mg · d ~ (-1). The control group was treated with 400 mg of CTX and 1 × 2 d every half moon for a total dose of no more than 8.0 g. Meanwhile, 30-60 mg · d -1 of prednisone was used in combination. 24, 24, 24 weeks urine protein quantitation, liver and kidney function, blood routine and adverse reactions were observed. Results: After 24 hours of treatment with leflunomide, urinary protein and serum albumin increased significantly (P <0.01), while renal function did not change much. Complete remission rate and total effective rate were higher than the CTX impact treatment group; but almost all patients had a transient increase in ALT of liver function, with liver protection treatment, the vast majority of patients can adhere to treatment, liver function returned to normal; other Adverse reactions are rare. Conclusion: Hormones combined with low-dose leflunomide can effectively and effectively relieve refractory renal disease. The recent clinical treatment response rate is higher than that of CTX impact treatment, and the long-term therapeutic effect remains to be seen.