摘要目的 探讨血液滤过联合药物治疗重症紫癜性肾炎的有效性.方法 将66例重症紫癜性肾炎患者按随机数字表法分为治疗组和对照组,每组33例.治疗组接受血液滤过联合常规泼尼松和环磷酰胺治疗,对照组接受常规泼尼松和环磷酰胺治疗,疗程均为1个月.观察两组患者治疗前、后的24 h尿蛋白定量、肾功能、超敏C反应蛋白、白细胞介素6、白细胞介素18、肿瘤坏死因子α水平的变化.结果 基线时两组患者在年龄、性别、病程、24 h尿蛋白定量、血肌酐、尿素氮、白细胞介素6、白细胞介素18和肿瘤坏死因子α水平比较差异无统计学意义(P＞0.05)；经治疗后,治疗组患者的白细胞介素6、白细胞介素18、肿瘤坏死因子α、超敏C反应蛋白、肌酐、尿素氮水平与治疗前比较差异有统计学意义(P＜ 0.05)；对照组患者治疗后肌酐、尿素氮、24h尿蛋白定量与治疗前比较差异也有统计学意义(P＜0.05),而白细胞介素6、肿瘤坏死因子α、超敏C反应蛋白指标与治疗前比较差异无统计学意义(P＞0.05).结论 血液滤过联合泼尼松、环磷酰胺治疗能有效降低重症紫癜性肾炎患者体内的炎症因子(白细胞介素6、白细胞介素18和肿瘤坏死因子α)水平,降低蛋白尿和改善肾功能.

abstractsObjective To investigate the clinical efficacy of hemofiltration combined with immunosuppressive drug in Henoch-Schonlein Purpura nephritis.Methods Sixty-six patients with Henoch-Schonlein purpura nephritis were enrolled in this randomized controlled trial.33 patients received hemofiltration combined with immunosuppressive drugs, prednisone and cyclophosphamide as treatment group for one month.The other 33 received oral cyclophosphamide combined with prednisone as control group for one month.The efficacy was assessed by determining the subsequent change in serum supersensitivity C reactive propein (HsCRP),IL-6,IL-18,TNF-α,creatinine (Scr),urea nitrogen (BUN) and 24 h urine protein.Results (1) At basline,there were no significant difference in the general data,such as age,gender,course,24 h urine protein,serum HsCRP,IL-6,IL-18,TNF-α,Ser and BUN in both groups.(2) After 1 month of the treatment,the level of serum HsCRP,IL-6,IL-18,TNF-α,Scr and BUN significantly decreased compared with the baseline in treatment group.The level of 24 h urine protein,Scr and BUN significantly decreased compared with the baseline in control group,but the level of serum HsCRP,IL-6,IL-18 and TNF-α were no changed compared with the baseline in control group.Conclusion Hemofiltration combined with immunosuppressive drug Leflunomide can effectively reduce the inflammatory factor in Henoch-Schonlein purpura nephritis,lower urine protein and improve renal fuction.