Effects of Leflunomide and Azathioprine on serum chemokine, cathepsin and vascular cell adhesion molecule-1 in elderly patients with lupus nephritis / 中华老年医学杂志

ABSTRACT

Objective:To investigate the effects of Leflunomide and Azathioprine on serum chemokine cx3cl1(fractalkine), cathepsin S and vascular cell adhesion molecule-1(VCAM-1)in elderly patients with lupus nephritis.Methods:Sixty elderly patients with lupus nephritis admitted to our hospital from January 2017 to July 2019 were selected as the research objects.Patients were divided into two groups by using a random number table method: the Leflunomide group(treated with Leflunomide plus conventional treatment)and the Azathioprine group(treated with azathioprine plus conventional treatment)(n=30, each group). Serum levels of fractalkine and cathepsin S and urine VCAM-1 level before and 6, 9 and 12 months after treatment were measured in the two groups and statistically analyzed.Results:In both groups, serum fractalkine levels were decreased after versus before treatment( F=123.029 and 99.041 respectively, P=0.000). At 6 months after treatment, serum fractalkine level was lower in the leflunomide group(2.34±0.95)μg/L than in the Azathioprine group(2.97±1.01)μg/L( t=2.489, P=0.016). Serum cathepsin S levels were decreased in both groups after treatment( F=106.733 and 64.928, P=0.000). Serum cathepsin S levels were lower in the Leflunomide group that in the azathioprine group at 6 and 9 months after treatment[(24.31±3.15)μg/L vs.(26.92±4.02)μg/L, (21.72±2.67)μg/L vs.(23.89±2.75)μg/L, t=2.799 and 3.101, P=0.007 and 0.003]. After treatment, urinary VCAM-1 levels were decreased in both two treatment groups( F=907.450 and 858.114, P=0.000). At 6 months after treatment, urine VCAM-1 level was lower in the Leflunomide group than in the Azathioprine group[(74.36±9.17)μg/L Cr vs.(86.91±9.22)μg/L Cr, t=5.286, P=0.000)]. The incidences of adverse reactions were low in the two groups, and the difference was not statistically significant. Conclusions:Leflunomide and Azathioprine can effectively reduce serum levels of fractalkine and cathepsin S and urinary VCAM-1 in elderly patients with lupus nephritis, which suggests that Leflunomide and Azathioprine have similar effects in inhibiting inflammatory reaction, cell matrix degradation and remodeling and vascular cell adhesion.But at early stage of therapy, the effect of Leflunomide was better than that of Azathioprine.And two drugs can be selected according to the specific clinical situation.