来氟米特联合糖皮质激素治疗进展性IgA肾病的疗效及对VCAM-1 水平的影响

目的:研究来氟米特联合糖皮质激素治疗进展性IgA肾病的疗效及对尿VCAM-1水平的影响。方法:选择2012年5月至2014年5月在我院接受治疗的进展性IgA肾病患者104例作为研究对象。按照随机数字表法分成实验组及对照组各52例,对照组予以常规治疗方案联合泼尼松药物治疗,实验组基于对照组基础另予来氟米特治疗,疗程均为6个月。采用全自动生化分析仪测定并比较两组患者治疗前后24 h尿蛋白定量、血白蛋白、血肌酐、肾小球滤过率(GFR)及尿血管细胞黏附分子(尿VCAM-1)水平,评价治疗后两组患者的临床疗效和药物不良反应。结果:(1)实验组的总有效率为94.23%,显著高于对照组的80.77%(P0.05);(2)两组治疗后尿蛋白定量、血肌酐水平及尿VCAM-1水平均显著低于治疗前,且实验组低于对照组;而治疗后血白蛋白及GFR水平均分别显著高于治疗前,实验组高于对照组(均P0.05);(3)治疗后实验组的药物总不良反应发生率与对照组相比,差异无统计学意义(P0.05)。结论:利用来氟米特与糖皮质激素联合治疗进展性IgA肾病患者,具有较好的疗效,可降低尿VCAM-1水平,且不会增加不良反应的发生,值得在临床推广应用。

Effect of Leflunomide Combined with Glucocorticoid in the Treatment ofProgressive IgA Nephropathy and Its Influence on VCAM-1 Level

Objective:To study the effect of leflunomide combined with glucocorticoid in the treatment of progressive IgAnephropathy and its influence on urine vascular cell adhesion molecule(VCAM-1) level.Methods:Selected 104 patients with progressiveIgA nephropathy who were treated in our hospital from May 2012 to May 2014 as the research objects. They were divided into experimentalgroup and control group with 52 patients in each group according to the random number table method, the control group was receivedconventional treatment combined with prednisone therapy, while the experimental group was added leflunomide based on the therapyof control group, the course of treatment were 6 months. Detected and compared the levels of urine protein, serumalbumin, serum creatinine,glomerular filtration rate (GFR) and urine VCAM-1 in the two groups 24 h before and after treatment by automatic biochemicalanalyzer, and evaluated the clinical efficacy and drug adverse reactions in two groups after treatment.Results:(1)The total effective ratein the experimental group was 94.23%, which was significantly higher than 80.77%in the control group (P<0.05); (2)The urine protein,serum creatinine and urine VCAM-1 levels in the two groups after treatment were significantly lower than before treatment, and the experimentalgroup was lower than control group; While the serum albumin and GFR were significantly higher than before treatment, andthe experimental group was higher than control group(P<0.05); (3)There was no significant difference in the total drug adverse reactionsbetween the experimental group and the control group(P>0.05).Conclusion:Leflunomide combined with glucocorticoid has good clinicalefficacy in the treatment of patients with progressive IgA nephropathy, which can reduce the urine VCAM-1 level,and will not increasethe incidence of drug adverse reactions, it is worth popularizing and applying in clinical field.