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

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>0.5 g/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。

Abstract:

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.