[关键词]
[摘要]
目的 探讨来氟米特联合甲泼尼龙协同恩替卡韦对乙肝相关性肾炎患者24 h尿蛋白定量及血清学指标的影响。方法 以漯河市中心医院肾内科2016年1月-2018年6月70例乙肝相关性肾炎患者为研究对象,根据入院单双号,随机数字表法均分为两组,其中对照组35例患者仅接受恩替卡韦治疗,观察组35例患者在对照组的基础上应用来氟米特联合甲泼尼龙片治疗,比较两组患者的治疗总有效率、治疗前后24 h尿蛋白定量及血清学指标变化。结果 观察组患者治疗总有效率为82.85%,显著高于对照组的51.42%,两组比较存在统计学差异(P<0.05)。与入院时相比,治疗3个月及6个月时两组患者的24 h尿蛋白定量均显著降低(P<0.05),且观察组显著低于对照组(P<0.05)。与治疗前相比,治疗后两组各血清学指标均显著降低(P<0.05),治疗后观察组患者丙氨酸氨基转移酶(ALT)、γ-干扰素(IFN-γ)与IFN-γ/IL-4水平均低于对照组(P<0.05)。结论 来氟米特联合甲泼尼龙可协同恩替卡韦减少蛋白尿定量,清除乙肝病毒,抑制IFN-γ的生成,疗效显著,对促进乙肝相关性肾炎患者病情恢复具有积极意义。
[Key word]
[Abstract]
Objective To investigate the effect of leflunomide combined with methylprednisolone on urinary protein quantification and serological indexes in patients with hepatitis associated nephritis at Urine protein quantitation for 24h and Serological indicators. Methods 70 cases of hepatitis b related nephritis patients in our hospital from January 2016 to June 2018 were selected as the research objects. Grouping according to the admission odd-even Numbers, Among them, 35 patients in the control group received entecavir treatment only, and 35 patients in the study group were treated with leflunomide combined with methylprednisolone on the basis of the control group. The total effective rate, the quantitative and serological changes of urinary protein at 24h before and after treatment were compared between the two groups.Results There were 82.85% of total effective treatment in the study group, which was significantly higher than that in the control group (51.42%), and there was a statistical difference between the two groups (P<0.05). Compared with the time of admission, the 24h urine protein content of the two groups was significantly lower at 3 months and 6 months after treatment, and the study group was significantly lower than the control group (P<0.05). Comparing with before treatment, all the serological indicators in the two groups were significantly decreased after treatment (P<0.05), and the ALT, IFN-γ and IFN-γ/IL-4 levels in the study group were significantly lower than those in the control group (P<0.05). Conclusion Leflunomide combined with methylprednisolone can reduce proteinuria, remove HBV and inhibit the production of IFN-γ. It has positive significance to promote the recovery of patients with hepatitis associated nephritis.
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[基金项目]
河南省医学教育研究项目(Wjlx2017225)