环磷酰胺、来氟米特联合泼尼松序贯疗法用于Ⅱ期膜性肾病的临床观察-中国药房

环磷酰胺、来氟米特联合泼尼松序贯疗法用于Ⅱ期膜性肾病的临床观察

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篇名：	环磷酰胺、来氟米特联合泼尼松序贯疗法用于Ⅱ期膜性肾病的临床观察
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摘要：	目的：观察环磷酰胺、来氟米特联合泼尼松序贯疗法用于Ⅱ期膜性肾病的疗效和安全性。方法：72例Ⅱ期膜性肾病患者随机分为A（24例）、B（24例）、C组（24例）。各组患者均给予盐酸贝那普利片、华法林、双嘧达嗼、钙剂等常规治疗。在此基础上，A组患者给予复方环磷酰胺片50 mg，口服，每日2次，连用3个月+醋酸泼尼松片1.0 mg/（kg·d），口服，连用2个月后每2周减5 mg ，减至30 mg时每2周再减2.5 mg，减至10 mg/d时再连用4～6个月，共计服用12个月；B组患者给予来氟米特片50 mg，口服，连用2 d后改为20 mg，再连用6个月+醋酸泼尼松片（用法用量同A组）；C组患者于第1～3月给予复方环磷酰胺片（用法用量同A组），第4～9月给予来氟米特片（用法用量同B组）+醋酸泼尼松片（用法用量同A组）。观察各组患者的临床疗效，治疗前和治疗3、6、9、12个月后24 h尿蛋白量、血浆白蛋白、总胆固醇、血肌酐、丙氨酸转氨酶及不良反应发生情况。结果：治疗前，各组患者24 h尿蛋白量、血浆白蛋白、总胆固醇、血肌酐、丙氨酸转氨酶比较，差异均无统计学意义（P＞0.05）。各组患者治疗后3、6、9、12个月的24 h尿蛋白量、总胆固醇、血肌酐及治疗后6、9、12个月的丙氨酸转氨酶均显著低于同组治疗前，随治疗时间的延长逐渐降低，且C组治疗后6、9、12个月的24 h尿蛋白量、总胆固醇均低于A、B组；各组患者治疗后3、6、9、12个月的血浆白蛋白均显著高于同组治疗前，随治疗时间的延长逐渐升高，且C组治疗后6、9、12个月均显著高于A、B组，差异均有统计学意义（P＜0.05或＜0.01），但A、B组间比较差异无统计学意义（P＞0.05）。C组患者总有效率显著高于A、B组，差异有统计学意义（P＜0.05），但A、B组间比较差异无统计学意义（P＞0.05）。各组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：在常规治疗的基础上，环磷酰胺、来氟米特联合泼尼松序贯疗法用于Ⅱ期膜性肾病疗效显著优于单用环磷酰胺或来氟米特，且安全性相当。
ABSTRACT：	OBJECTIVE： To observe the efficacy and safety of cyclophosphamide， leflunomide sequentially combined with prednisone in the treatment of membranous nephropathy in stage Ⅱ. METHODS： 72 patients with membranous nephropathy in stage Ⅱ were randomly divided into group A（24 cases）， B（24 cases） and C（24 cases）. All patients were given angiotensin converting enzyme inhibitor （ACEI） Benazepril hydrochloride tablet， warfarin， dipyridamole， calcium and other conventional treatment. Based on it， group A was orally given 50 mg Compound cyclophosphamide tablet， twice a day， for continuous 3 months+1.0 mg/（kg·d） Prednisone tablet， it was reduced 5 mg every 2 weeks after 2 months， then it reduced 2.5 mg every 2 weeks when 30 mg/day， and then it maintained 4-6 months when 10 mg/day， it lasted for 12 months. Group B was given 50 mg Leflunomide tablet， it changed as 20 mg/day after 2 d， and for continuous 6 months+Prednisone tablet （the same dosage and usage as group A）. Group C was given Compound cyclophosphamide tablet （the same dosage and usage as group A） was orally given in 1-3 months， and Leflunomide tablet （the same dosage and usage as group B） in 4-9 months Prednisone tablet （the same dosage and usage as group A）. Clinical efficacy， 24 h urinary protein， albumin， total cholesterol， serum creatinine， alanine aminotransferase before and after 3， 6， 9 and 12 months and incidence of adverse reactions in all groups were observed. RESULTS： Before treatment， there were no significant differences in the 24 h urinary protein， albumin， total cholesterol， serum creatinine and alanine aminotransferase among all groups （P＞0.05）. After treatment， 24 h urinary protein， total cholesterol， serum creatinine and alanine aminotransferase in all groups were significantly lower than before， and they gradually decreased by treatment time， 24 h urinary protein in group C was lower than group A and B， albumin was significantly higher than before and gradually increased by treatment time， and group C was higher than group A and B， the differences were statistically significant （P＜0.05 or P＜0.01）； but there was no significant difference between group A and B （P＞0.05）. The total effective rate in group C was significantly higher than group A and B， the difference was statistically significant （P＜0.05）， but there was no significant difference between group A and B （P＞0.05）. And there was no significant difference in the incidence of adverse reactions among 3 groups （P＞0.05）. CONCLUSIONS： Based on the conventional treatment， the efficacy of cyclophosphamide， leflunomide sequentially combined with glucocorticoid is superior to cyclophosphamide or leflunomide alone in the treatment of membranous nephropathy in stage Ⅱ， with similar safety.
期刊：	2016年第27卷第15期
作者：	刘书真，谢泉琨，党勇
AUTHORS：	LIU Shuzhen，XIE Quankun，DANG Yong
关键字：	来氟米特；泼尼松；环磷酰胺；膜性肾病；疗效；安全性
KEYWORDS：	Leflunomide； Prednisone； Cyclophosphami- de； Membranous nephropathy； Efficacy； Safety
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