目的 探討來氟米特聯(lián)合甲潑尼龍協(xié)同恩替卡韋對乙肝相關性腎炎患者24 h尿蛋白定量及血清學指標的影響。方法 以漯河市中心醫(yī)院腎內(nèi)科2016年1月-2018年6月70例乙肝相關性腎炎患者為研究對象，根據(jù)入院單雙號，隨機數(shù)字表法均分為兩組，其中對照組35例患者僅接受恩替卡韋治療，觀察組35例患者在對照組的基礎上應用來氟米特聯(lián)合甲潑尼龍片治療，比較兩組患者的治療總有效率、治療前后24 h尿蛋白定量及血清學指標變化。結果 觀察組患者治療總有效率為82.85%，顯著高于對照組的51.42%，兩組比較存在統(tǒng)計學差異（P<0.05）。與入院時相比，治療3個月及6個月時兩組患者的24 h尿蛋白定量均顯著降低（P<0.05），且觀察組顯著低于對照組（P<0.05）。與治療前相比，治療后兩組各血清學指標均顯著降低（P<0.05），治療后觀察組患者丙氨酸氨基轉(zhuǎn)移酶（ALT）、γ-干擾素（IFN-γ）與IFN-γ/IL-4水平均低于對照組（P<0.05）。結論 來氟米特聯(lián)合甲潑尼龍可協(xié)同恩替卡韋減少蛋白尿定量，清除乙肝病毒，抑制IFN-γ的生成，療效顯著，對促進乙肝相關性腎炎患者病情恢復具有積極意義。

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.

河南省醫(yī)學教育研究項目（Wjlx2017225）