非诺贝特治疗脂蛋白肾病的回顾性分析  

Fenofibrate in the treatment of patients with lipoprotein nephropathy

作　　者：范文静[1] 葛永纯[2] 周岩[2] 周玉超[2] 曾彩虹[2] 陈惠萍[2] 刘志红[2] 程震[2] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科,硕士研究生南京210016 [2]南京大学医学院附属金陵医院(南京军区南京总医院)国家肾脏疾病临床医学研究中心全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2016年第1期25-29,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04;2015BAI12B05);江苏省临床医学科技专项(BL2012007)

摘　　要：目的：回顾性分析非诺贝特治疗脂蛋白肾病的长期疗效。方法：2003年至2013年在南京军区南京总医院肾脏科肾活检确诊脂蛋白肾病者共45例,30例随访〉24月,其中15例接受非诺贝特治疗（200~400mg/d）设为贝特组;15例未用贝特类药物的患者为对照组。结果：贝特组与对照组患者主要临床指标[血清肌酐（SCr）、白蛋白（Alb）和载脂蛋白E（Apo E）水平、尿蛋白定量）]基线值相当（P〉0.05）;治疗12、24月后,贝特组尿蛋白定量、SCr及Apo E水平显著低于对照组,Alb显著高于对照组（P值均〈0.05）,贝特组患者尿蛋白水平缓慢下降,SCr稳定,Alb逐渐上升;对照组尿蛋白及SCr水平逐渐升高,Alb逐渐下降。两组Apo E水平均有下降,但贝特组治疗24月后血Apo E水平对比差异显著,对照组前后比较无统计学差异。生存分析提示贝特组肌酐倍增的中位时间为71.62月,对照组为34.78月,贝特组预后优于对照组,两者相比差异显著。结论：非诺贝特可降低脂蛋白肾病患者尿蛋白及血Apo E水平,延缓肾功能不全的进展。Objective： Lipoprotein glomerulopathy is a rare inherited disease caused by the abnormal metabolism of Apolipoprotein E（ Apo E）. The objective of this study is to retrospectively observe the effect of fenofibrate in Chinese patients with lipoprotein glomerulopathy（ LPG）. Methodology： From 2003 to 2013,thirty patients were diagnosed as LPG in our hospital and were followed up for more than 2 years. Patients who received fenofibrate at a dose of 200- 400 mg / d for at least 24 months were assigned to Brate group（ n = 15）,and patients who didn＇t recieve fenofibrate were assigned to control group（ n = 15）. Results：（ 1） Baseline： The baseline parameters including serum creatinine,albumin,Apo E levels and urine protein between two groups were not significantly different（ P〈0. 05）.（ 2） Clinical effect：After 24 months＇ treatment,lipid profiles,proteinuria,and serum albumin were improved in Brate group. In Brate group,the urinary albumin was lower after 12 to 24 months＇ treatment,serum creatinine was decreased slightly,and serum albumin was increased. However,the post-treatment parameters were deteriorated in the control group.（ 3） Prognosis： In Brate group,11 patients（ 73. 3%） reached remission（ complete plus partial remission）,and 3 patients（ 20. 0%） presented with a doubling of serum creatinine. In control group,only one（ 6. 6%） reached complete remission,and 11 patients（ 73. 3%） were a doubling of serum creatinine. Survival analysis showed that the median time to doubling of serum creatinine was 71. 6 vs 34. 8 months in Brate group and control group（ P〈0. 05）. Conclusion： Fenofibrate can induce remission of lipoprotein glomerulopathy and decelerate the progress of renal insufficiency.

关 键 词：脂蛋白肾病 非诺贝特 预后 

分 类 号：R692[医药卫生—泌尿科学]