丙酸氟替卡松吸入气雾剂联合ACEI/ARB治疗IgA肾病的临床观察  

Clinical observation of fluticasone propionate inhalation aerosol combined with ACEI/ARB in the treatment of IgA nephropathy

作　　者：袁湘宁[1] 杨敬华[1] 唐家乐 廖中华 罗丽颖 肖湘成[1] 许辉[1] 周巧玲[1] 李晓照[1] Xiang-ning Yuan;Jing-hua Yang;Jia-le Tang;Zhong-hua Liao;Li-ying Luo;Xiang-cheng Xiao;Hui Xu;Qiao-ling Zhou;Xiao-zhao Li(Department of Nephrology,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院肾内科,湖南长沙410008

出　　处：《中国现代医学杂志》2020年第18期57-61,共5页China Journal of Modern Medicine

基　　金：国家自然科学基金青年基金(No:81900679);湖南省自然科学基金面上项目(No:2020JJ4887);湖南省中医药科研计划项目(No:201325)。

摘　　要：目的探讨丙酸氟替卡松吸入气雾剂联合血管紧张素转化酶抑制剂或血管紧张素受体阻断剂(ACEI/ARB)治疗IgA肾病的有效性和安全性。方法采用前瞻性随机对照研究方法,将经3个月足量ACEI/ARB治疗,尿蛋白仍>0.5g/d的原发性IgA肾病患者随机分为治疗组和对照组,每组17例。治疗组给予丙酸氟替卡松吸入气雾剂250μg/次,2次/d,同时联合ACEI/ARB治疗;对照组仅给予ACEI/ARB治疗。入组后第3、6和9月各随访1次。结果治疗组与对照组0、3、6和9个月的的尿总蛋白/尿肌酐比值在不同组间有差别(P<0.05),在不同时间、变化趋势上无差别(P>0.05)。治疗组与对照组0、3、6和9个月的的eGFR在不同时间、不同组间、变化趋势上无差别(P<0.05)。治疗组与对照组0、3、6和9个月的尿总蛋白/尿肌酐比值变化率、eGFR变化率在不同时间、不同组间、下降趋势上有差别(P<0.05)。所有患者未发生严重不良反应。结论丙酸氟替卡松吸入气雾剂联合ACEI/ARB治疗IgA肾病可有效降低患者的蛋白尿水平,延缓eGFR下降。Objective To investigate the efficacy and safety of fluticasone propionate inhalation aerosol combined with angiotensin converting enzyme inhibitor or angiotensin receptor blocker(ACEI/ARB)in the treatment of IgA nephropathy.Methods Thirty-four patients with primary IgA nephropathy who had been treated with ACEI/ARB for 3 months but continued to develop proteinuria more than 0.5g/d were enrolled to this prospective randomized controlled study.Patients were randomly divided to the treatment group and the control group,with 17 cases in each group.The treatment group was treated with fluticasone propionate inhalation aerosol(250μg Bid)combined with ACEI/ARB,while the control group was treated with ACEI/ARB only.The patients were followed up at 3 months,6 months and 9 months after enrollment.Results There were differences in the change rate of urinary total protein to creatinine ratio and eGFR from baseline to different time points(P<0.05).The change rate of urinary total protein to creatinine ratio and eGFR from baseline between treatment group and control group was significantly different(P<0.05).Besides,the trends of the change rate of urinary total protein to creatinine ratio and eGFR from baseline were different between the two groups(P<0.05).No severe adverse reactions occurred in all patients.Conclusions Fluticasone propionate combined with ACEI/ARB in the treatment of IgA nephropathy can effectively reduce the urinary protein level and slow the decline of eGFR.

关 键 词：IgA肾病/肾小球肾炎IgA 丙酸氟替卡松/糖皮质激素类 血管紧张素转换酶抑制药 血管紧张素受体阻断剂 蛋白尿 

分 类 号：R692.31[医药卫生—泌尿科学]