目的 探討來氟米特片對老年糖尿病腎病的臨床療效.方法 將86例老年糖尿病腎病患者隨機分為2組.對照組采用常規(guī)降壓、降糖治療,治療組患者增加來氟米特片,口服,首劑量50 mg/次,1次/d,連續(xù)3 d后改為20 mg/次,1次/d,連續(xù)治療4周.比較兩組患者療效及炎性因子、基質(zhì)金屬蛋白酶-2(MMP-2)和β₂-微球蛋白(β₂-MG)變化.結(jié)果 治療組緩解率86.05%,對照組74.42%,兩組比較差異具有統(tǒng)計學(xué)意義(P<0.01);治療后兩組患者血糖均達(dá)到控制目標(biāo),尿蛋白定量、血清白蛋白(ALB)、肌酐(Cr)、尿素氮(BUN)均明顯好轉(zhuǎn)(P<0.05),與對照組比較,治療組改善更為顯著,差異具有統(tǒng)計學(xué)意義(P<0.01);治療后兩組白細(xì)胞介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)、高敏C-反應(yīng)蛋白(hs-CRP)差異均有統(tǒng)計學(xué)意義(P<0.05);治療后兩組患者M(jìn)MP-2和β₂-MG與治療前比較差異均有統(tǒng)計學(xué)意義(P<0.05),但只有兩組MMP-2差異有區(qū)別(P<0.05).結(jié)論 來氟米特片對糖尿病腎病患者的腎功能具有保護(hù)作用,其機制可能與機體炎癥刺激狀態(tài)和MMP-2的合成有關(guān).

Objective To investigate the clinical effect of Leflunomide Tablets on diabetic nephropathy. Methods Patients (86 cases) were randomly divided into two groups. Patients in the control group were given conventional antihypertensive and antidiabetic treatment. Patients in the treatment group were po administered with Leflunomide Tablets with the first dosage of 50 mg/time, once daily, and rested for 3 d. Then the administration was repeated to 20 mg/time, once daily for 4 weeks. Clinical effect and changes of inflammatory factors, MMP-2, and β₂-MG in the two groups were compared. Results The significant remission rates in the treatment and control groups were 86.05% and 74.42%, respectively, and there were differences between the two groups (P < 0.01). After treatment, blood glucose in the two groups reached control goal, and urine protein, ALB, Cr, and BUN were improved significantly (P < 0.05). The parameters in the treatment group were improved more significantly than those in the control group, and the differences were statistically significant (P < 0.01). After treatment, these levels of IL-6, TNF-α, and hs-CRP in the treatment group were improved better than those of control group with significant difference between the two groups (P < 0.05). There were differences of MMP-2 and β₂-MG levels between the two groups after treatment (P < 0.05), but only levels of MMP-2 in the two groups had difference (P < 0.05) Conclusion Leflunomide Tablets have protective effect on renal function in patients with diabetic nephropathy, and the mechanism may be related to inflammatory stimulation and MMP-2 generation.