CAJ | 학술논문

目的：观察来氟米特联合醋酸泼尼松治疗特发性膜性肾病的疗效。方法经肾脏穿刺活检确诊特发性膜性肾病患者30例采用随机数字表法分为两组各15例，A组给予来氟米特联合醋酸泼尼松治疗， B组给予环磷酰胺联合醋酸泼尼松治疗，疗程均为6个月。比较两组临床疗效、24 h尿蛋白定量，血浆白蛋白、血脂、肾功能等指标及不良反应。结果 A组治疗3、6个月缓解率为60．00％、73．33％，B组为53．33％、66.67％，差异均无统计学意义（χ2＝0．965、0．896，均P＞0．05）。两组治疗后24 h尿蛋白定量、血浆白蛋白[A组：（1．33±1．25）g/24 h，（38．24±4．84）g/L；B组：（1．42±1．37）g/24 h，（37．12±5．43）g/L]均较治疗前[A组：（7．34±2．75）g/24 h，（20．31±7．33）g/L；B组：（7．22±2．84）g/24 h，（20．46±7．73）g/L]显著下降（A组：t＝6．232、5．734，均P＜0．05；B组：t＝5．934、5．267，均P＜0．05）；两组治疗后总胆固醇、三酰甘油[A组：（6．74±1．45）mmol/L，（2．43±0．75）mmol/L；B组：（6．63±1．45）mmol/L，（2．14±0．63）mmol/L]均较治疗前[ A 组：（11．94±2．98） mmol/L，（3．56±1．35） mmol/L；B 组：（11．53±2．84） mmol/L，（3．24±1．46）mmol/L]显著下降（A组：t＝6．246、5．234，均P＜0．05；B组：t＝5．256、5．672，均P＜0．05）；A组、B组治疗后尿素氮、血肌酐与治疗前差异均无统计学意义（均P＞0．05）；治疗后两组上述各指标差异均无统计学意义（均P＞0.05）。 A组不良反应率（13．33％）低于B组（40．00％）（χ2＝4．246，P＜0．05）。结论来氟米特与环磷酰胺分别联合醋酸泼尼松治疗特发性膜性肾病疗效相当，但来氟米特不良反应发生率较低。
목적：관찰래불미특연합작산발니송치료특발성막성신병적료효。방법경신장천자활검학진특발성막성신병환자30례채용수궤수자표법분위량조각15례，A조급여래불미특연합작산발니송치료， B조급여배린선알연합작산발니송치료，료정균위6개월。비교량조림상료효、24 h뇨단백정량，혈장백단백、혈지、신공능등지표급불량반응。결과 A조치료3、6개월완해솔위60．00％、73．33％，B조위53．33％、66.67％，차이균무통계학의의（χ2＝0．965、0．896，균P＞0．05）。량조치료후24 h뇨단백정량、혈장백단백[A조：（1．33±1．25）g/24 h，（38．24±4．84）g/L；B조：（1．42±1．37）g/24 h，（37．12±5．43）g/L]균교치료전[A조：（7．34±2．75）g/24 h，（20．31±7．33）g/L；B조：（7．22±2．84）g/24 h，（20．46±7．73）g/L]현저하강（A조：t＝6．232、5．734，균P＜0．05；B조：t＝5．934、5．267，균P＜0．05）；량조치료후총담고순、삼선감유[A조：（6．74±1．45）mmol/L，（2．43±0．75）mmol/L；B조：（6．63±1．45）mmol/L，（2．14±0．63）mmol/L]균교치료전[ A 조：（11．94±2．98） mmol/L，（3．56±1．35） mmol/L；B 조：（11．53±2．84） mmol/L，（3．24±1．46）mmol/L]현저하강（A조：t＝6．246、5．234，균P＜0．05；B조：t＝5．256、5．672，균P＜0．05）；A조、B조치료후뇨소담、혈기항여치료전차이균무통계학의의（균P＞0．05）；치료후량조상술각지표차이균무통계학의의（균P＞0.05）。 A조불량반응솔（13．33％）저우B조（40．00％）（χ2＝4．246，P＜0．05）。결론래불미특여배린선알분별연합작산발니송치료특발성막성신병료효상당，단래불미특불량반응발생솔교저。
Objective To observe the effect of leflunomide and cyclophosphamide combined with prednisone in the treatment of idiopathic membranous nephropathy .Methods 30 patients with idiopathic membranous nephropa-thy were randomly divided into two groups ,15 cases in each group .A group was treated by leflunomide combined with prednisone , B group was treated by cyclophosphamide combined with prednisone , 6 months a course .The clinical effect,24h urine protein quantity,serum albumin levels,blood fat,renal functions and adverse reactions were com-pared.Results 3,6 months after treatment ,the remission rates in A group were 60.00%,73.33%,those in B group were 53.33%,66.67%(χ2 =0.965,0.896,all P>0.05).After treatment,24h urine protein quantity,serum albu-min levels in the two groups [A group:(1.33 ±1.25)g/24h,(38.24 ±4.84)g/L;B group:(1.42 ±1.37)g/24h, (37.12 ±5.43)g/L] were significantly lower than those before treatment [A group:(7.34 ±2.75)g/24h,(20.31 ± 7.33)g/L;B group:(7.22 ±2.84)g/24h,(20.46 ±7.73)g/L] (A group:t=6.232,5.734,all P<0.05;B group:t=5.934,5.267,all P<0.05).After treatment,total cholesterol,triglyceride in the two groups [A group:(6.74 ± 1.45)mmol/L,(2.43 ±0.75)mmol/L;B group:(6.63 ±1.45)mmol/L,(2.14 ±0.63)mmol/L] were significantly lower than those before treatment [A group:(11.94 ±2.98) mmol/L,(3.56 ±1.35) mmol/L;B group:(11.53 ± 2.84)mmol/L,(3.24 ±1.46)mmol/L] (A group:t=6.246,5.234,all P<0.05;B group:t=5.256,5.672,all P<0.05).There were no significant differences in urea nitrogen ,serum creatinine between before and after treatment in the two groups(all P>0.05).There were no significant differences in above indicators between A group and B group after treatment (all P>0.05).The incidence rate of adverse reactions in A group (13.33%) was significantly lower than that in B group(40.00%)(χ2 =4.246,P<0.05).Conclusion The clinical efficacy of leflunomide is similar to cyclophosphamide in treating idiopathic membranous nephropathy with fewer adverse reactions .