来氟米特合并小剂量激素治疗难治性肾病综合征疗效观察.doc

来氟米特合并小剂量激素治疗难治性肾病综合征疗效观察 　　作者：张涛,贺利成,叶良君　　作者单位：武警湖南总队机关门诊部，湖南 长沙 　　【摘要】目的：探讨来氟米特合并小剂量激素治疗难治性肾病综合征的临床疗效。方法：将54例难治性肾病综合征患者随机分为观察组和对照组，观察组28例，给予来氟米特合并小剂量激素治疗，对照组26例给予环磷酰胺合并小剂量激素，疗程6个月。结果：总有效率观察组为89.29%(25/28)明显高于对照组73.08%(19/26)(P〈0.05);治疗后24 h尿蛋白量、血白蛋白和血肌酐降低程度，观察组明显优于对照组，两组比较差异有统计学意义(P〈0.05);观察组不良反应发生率为17.85%明显低于对照组30.77%，差异有统计学意义(P〈0.05)。结论：来氟米特合并小剂量激素治疗难治性肾病综合征比CTX具有治愈率高，并发症少等特点，值得临床推广使用。 　　【关键词】 来氟米特,激素,环磷酰胺,肾病综合征 　　[ABSTRACT] Objective： To investigate the clinical efficacy of leflunomide combined with low-dose steroids in the treatment of refractory nephrotic syndrome. Methods： A total of 54 cases of nephrotic syndrome were randomly divided into the observation group and the control group. Twenty eight patients in the observation group were treated with leflunomide combining with low-dose hormone， while 26 patients in the control group were given cyclophosphamide combining with low-dose steroids. After six monts of treatment， clinical efficacy of the two groups were observee and compared. Results： Total efficacy rate of the observation group (89.29%， 25/28)was significant higher than that of the control group (73.08%,19/26)(P〈0.05). After 24 hours treatment， decrease in urinary protein quantity， serum albumin and blood creatinine was all significant obvious than that in the control group (P〈0.05). The observation group obviously showed significant lower incidence of side effectsthan the control group (17.85% vs. 30.77%，P〈0.05). Conclusion： Leflunomide combining with low-dose steroids is effective on refractory nephrotic syndrome with less side effects， and it′s worthy of application in clinic. 　　[KEY WORDS] Leflunomide; Steroids; Cyclophosphamide; Refractory nephrotic syndrome 　　难治性肾病综合征是指原发性肾病综合征具备下列任何一项特征者：(1)经强的松标准疗程治疗无效者称为激素无效型肾病;(2)经强的松标准疗程治疗缓解但常复发(1年内复发3次或半年内复发超过2次者)称为常复发型肾病综合征;(3)糖皮质激素停药或减量2周内复发或反复且重复3次以上者[1]。约占原发性肾病综合征的30%～50%左右，是目前临床肾病中治疗最为棘手、预后较差的病种，本文通过对难治性肾病综合征患者分别给予来氟米特和环磷酰胺合并小剂量激素治疗，探讨分析其临床疗效与安全性，现分析如下。 　　1　资料与方法 　　1.1　一