IgA肾病患者使用肾素血管紧张素系统抑制剂的真实世界研究  

Application of renin-angiotensin system inhibitors in patients with IgA nephropathy:a real-world study

作　　者：李彩凤 林丽瑜 黄英 滕杰 Li Caifeng;Lin Liyu;Huang Ying;Teng Jie(Department of Nephrology,Zhongshan Hospital(Xiamen),Fudan University,Xiamen 361015,China;Nephrology Clinical Quality Control Center of Xiamen,Xiamen 361015,China)

机构地区：[1]复旦大学附属中山医院厦门医院肾内科,福建厦门361015 [2]厦门市肾病专业质量控制中心,福建厦门361015

出　　处：《实用药物与临床》2024年第7期506-510,共5页Practical Pharmacy and Clinical Remedies

基　　金：福建省2023年省级临床重点专科建设项目,厦门市自然科学基金项目(3502Z202374020)。

摘　　要：目的调查根据指南及质控标准应使用肾素血管紧张素系统(RAS)抑制剂治疗的IgA肾病患者RAS抑制剂的实际使用率、用药剂量、治疗效果及未使用的原因。方法选择2019年1月至2023年6月在复旦大学附属中山医院厦门医院诊断为原发性IgA肾病且根据指南和质控标准有RAS抑制剂使用适应证而无禁忌证[尿蛋白定量≥0.5 g/d且肾小球滤过率(eGFR)≥30 ml/min、无肾动脉狭窄或低血压]的患者154例,将其中使用RAS抑制剂且随访资料完整的患者122例,根据是否使用糖皮质激素分为RAS抑制剂联合激素组(52例)、RAS抑制剂组(70例),收集患者的临床资料、肾脏病理及实验室指标,记录患者RAS抑制剂及糖皮质激素使用情况,随访尿蛋白、血清肌酐、eGFR、钾及血压等变化情况并进行统计分析。结果154例患者中有132例使用RAS抑制剂治疗,RAS抑制剂的使用率为85.7%,87.1%的患者使用了标准剂量,3.8%的患者使用了0.5倍剂量,9.1%的患者使用了双倍剂量。无论是否联用糖皮质激素,RAS抑制剂治疗后,患者尿蛋白排泄均较治疗前下降[0.30(0.15,0.66)g/d vs.1.83(1.21,2.37)g/d,0.33(0.20,0.61)g/d vs.1.05(0.70,1.63)g/d](P<0.05),eGFR维持稳定。未使用RAS抑制剂的患者22例,其中10例因轻中度肾功能不全未用药,5例因合并急性肾损伤(AKI)未使用,4例因基础血压<100/60 mmHg未使用,1例因高钾血症未使用。结论RAS抑制剂可减少IgA肾病患者尿蛋白排泄,大部分IgA肾病患者能遵循指南使用RAS抑制剂治疗,未用药的主要原因是轻中度肾功能不全和基础血压偏低,严密监测肾功能和血压可能有助于提高RAS抑制剂的使用率。Objective To investigate the usage rate,dosage and efficacy of RAS inhibitors in IgA nephropathy patients requiring the treatment based on guidelines and quality control standards,as well as the reasons for no-use.Methods From January 2019 to June 2023,a total of 154 patients who were diagnosed with primary IgA nephropathy and met the indications for the use of RAS inhibitors according to guidelines and quality control standards and had no contraindications[urine protein quantification≥0.5 g/d and estimated glomerular filtration rate(eGFR)≥30 ml/min,no renal artery stenosis or hypotension]were selected,and among them,122 patients treated with RAS inhibitors and with complete follow-up data were divided into two groups based on whether glucocorticoids therapy was administered:70 patients in the RAS inhibitor group and 52 patients in the RAS inhibitor combined with glucocorticoids group.The clinical characteristics,renal pathological features and laboratory parameters were collected,the prescription of RAS inhibitors and glucocorticoids was recorded,and the change in the urinary protein,serum creatinine,eGFR,blood pressure and potassium was statistically analyzed.Results A total of 132 patients were prescribed with the RAS inhibitors,the usage rate being 85.7%;87.1%patients received standard dose,3.8%patients received half dose,and 9.1%patients received double doses.Regardless of whether glucocorticoids were used in combination,patients treated with RAS inhibitors showed a decrease in urinary protein excretion compared to before treatment[0.30(0.15,0.66)g/d vs.1.83(1.21,2.37)g/d,0.33(0.20,0.61)g/d vs.1.05(0.70,1.63)g/d,P<0.05],and the eGFR maintained steadily.Of the 22 patients that did not use the RAS inhibitors,10 patients were due to mild to moderate renal insufficiency,5 patients due to AKI,4 patients for baseline blood pressure<100/60 mmHg,and one patient for complication with hyperpotassemia.Conclusion RAS inhibitors can reduce the urinary protein excretion of IgA nephropathy patients;most patients receiv

关 键 词：IGA肾病 肾素血管紧张素系统抑制剂 蛋白尿 肾小球滤过率 质量控制 真实世界研究 

分 类 号：R692.31[医药卫生—泌尿科学]