目的 探討舒洛地特軟膠囊聯(lián)合來(lái)氟米特片治療膜性腎病的臨床療效。方法 收集2015年5月-2017年5月在陜西省第四人民醫(yī)院治療的膜性腎病患者68例，根據(jù)用藥的差別分為對(duì)照組（34例）和治療組（34例）。對(duì)照組口服來(lái)氟米特片，前3 d 50 mg/次，1次/d，然后20 mg/次，1次/d維持治療；治療組在對(duì)照組的基礎(chǔ)上口服舒洛地特軟膠囊，250 LSU/次，2次/d。兩組均經(jīng)過(guò)4周治療。評(píng)價(jià)兩組患者臨床療效，同時(shí)比較治療前后兩組患者腎功能指標(biāo)、血脂、血清白蛋白（ALB）和纖維蛋白原（FIB）水平以及血清學(xué)指標(biāo)。結(jié)果 治療后，對(duì)照組臨床總有效率為64.71%，顯著低于治療組的82.35%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者24 h尿蛋白（24 h UTP）、血肌酐（Scr）、血尿素氮（BUN）、FIB、總膽固醇（TC）、三酰甘油（TG）水平均明顯降低，ALB水平明顯升高，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組患者上述指標(biāo)改善程度明顯優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者血清高流動(dòng)性組蛋白-1（HMGB-1）、核轉(zhuǎn)錄因子-κB（NF-κB）、基質(zhì)金屬蛋白酶抑制因子-1（TIMP-1）和抗磷脂酶A2受體（PLA2R）水平均顯著降低，同組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組患者血清學(xué)指標(biāo)水平低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 舒洛地特軟膠囊聯(lián)合來(lái)氟米特片治療膜性腎病可有效改善患者腎功能，降低血脂水平，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of sulodexide combined with leflunomide in treatment of membranous nephropathy. Methods Patients (68 cases) with membranous nephropathy in the Fourth People's Hospital of Shaanxi from May 2015 to May 2017 were divided into control (34 cases) and treatment (34 cases) groups according to different treatments. Patients in the control group were po administered with Leflunomide Tablets, 50 mg/time for the first 3 d, then 50 mg/time, once daily. Patients in the treatment group were po administered with Sulodexide Soft Capsules on the basis of the control group, 50 LSU/time, twice daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the renal function indexes, serum lipids, but ALB and FIB levels, and serological indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 64.71%, which was significantly lower than 82.35% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the 24 h UTP, Scr, BUN, FIB, TC, and TG levels in two groups were significantly decreased, ALB levels were significantly increased, and there were differences in the same group (P<0.05). And these indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the HMGB-1, NF-κB, TIMP-1, anti-PLA2R levels in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the serological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Sulodexide combined with leflunomide can effectively improve renal function and reduce blood lipid levels in treatment of membranous nephropathy, which has a certain clinical application value.