2012 34 5 339 ACEI/ARB IgA * (ACEI/ARB)IgA 32 3 ACEI/ARB 0.5 g/d IgA 16 (20 mg/d) ACEI/ARB ACEI/ARB 1 4 8 12 6 9 1 9-43.6%[95% (CI):-71.2%~-16.1%] 15.1%(95%CI:-18.7%~48.9%) (P = 0.007) (1.5 g/d vs. 0.7 g/dp = 0.008) (1.1 g/d vs. 1.1 g/dp = 0.996) 9 (56.3%) 1 (6.3%P = 0.003) 2 ACEI/ARB IgA IgA Clinical observational study on the effectiveness of ACEI/ARB combined with Spironolactone for the treatment of IgA nephropathy ZHANG Qing-xian LI Yue-ting QIN Shao-hua et al (Department of Nephrology the First Hospital Peking University Beijing 100044) Abstract Objective The purpose of this study was to evaluate the efficacy and safety of combining spironolactone and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the treatment of IgA nephropathy (IgAN). Methods Thirty-two patients with IgAN who had already been treated with ACE inhibitors or ARBs for at least 3 months and continued to have proteinuria greater than 0.5 g/24 h were enrolled into this open-label randomized non-placebo-controlled study. The patients were randomly allocated to spironolactone (20 mg/day) plus ACE inhibitors/arbs (spironolactone group n=16) or ACE inhibitors/arbs alone (control group n=16)group. The primary end point was a comparison of changes in 24-hour urinary protein excretion level from the baseline to the last measurement during the study period. Results By the end of the ninth month of treatment the mean change in urinary protein excretion was -43.6% (95% CI -71.2% to -16.1%) in the spironolactone group and 15.1% (95%CI -18.7% to 48.9%) in the control group (P = 0.007). There was a significant decrease in proteinuria in the spironolactone-treated group (1.5 to 0.7 g/24 h P = 0.008) but not in the control group (from 1.1 to 1.1 g/24 h P = 0.996). The secondary end point was the achieving of persistent of proteinuria less than 0.5 g/24 h which was attained by one patient our of 16 (6.3%) in the control group and nine out of 16 (56.3%) in the spironolactone group (P = 0.003). Two male patients in the spironolactone group developed gynecomastia during the trial. Conclusions This study suggests that the addition of spironolactone to ACE inhibitors or ARBs can result in a significant decrease in proteinuria in IgAN. Key words IgA nephropathy Proteinuria Spironolactone (ACEI) [1] RAAS CKD (ARB) - (RAAS) (CKD) ( 100044) *
340 2012 34 5 ACEI/ARB ACEI/ARB 8 3 6 9 1 [23] 24 h (MRB) ACEI ()ARB MRB CKD [1112] CKD IgA 30%~ 40% 10 ~20 (ESRD) [4~6] IgA = / 24 h IgA ; = 24 h - [7] IgA 24 h ACEI ()ARB IgA 0.5 g/d [89] MRB IgA SPSS 16.0 x 軃 ± s ACEI/ARB IgA 2007 3~12 IgA :1 18~65 ; 2 3 ACEI/ARB 16 9 130/80 mmhg 2 2 7 8 0.5 g/d;3 (egfr) 60 ml/(min 1.73 m 2 ) [10] :1 5.0 mmol/l;2 1 (1)ACEI/ARB ; 3 10.5(3~28) 12(3~29)(P ;4 = 0.6) ACEI ARB DDD (1.5 ± 0.9 vs. 1.6 ± 0.6P = 0.7) ;5 IgA ACEI/ARB (MAP) 1/3 t Kaplan-Meier log rank 6 9 (1.5±0.9) IgA SAS (0.9±0.6) (0.9±0.7) (0.7±0.5)g/d(P = 0.008) (1A) 9 ACEI/ARB -43.6%[95% 20 mg/d ; (CI):-71.2%~-16.1%]+15.1% (95% CI: ACEI/ARB ACEI/ARB -18.7%~+48.9%) ( <130/80 mmhg ACEI/ARB -58.7% 95% CI:-100.2%~-17.3% ;P = 0.007) (DDD) 1B ( -0.79 g/d 95% CI:-1.42~-0.16 g/d;p = 0.016) 9 (56.3%) 9 1 4 1 (6.3%) (P = 0.003) 32 IgA 3
2012 34 5 341 (n=16) (n=16) (y) 34.5±11.1 37.4±9.3 0.4 (/) 9/7 7/9 0.7 (mmhg) 113.4±11.8 120.3±8.8 0.1 (mmhg) 74.7±19.8 80.6±10.5 0.1 (g/d) 1.5±0.9 1.1±0.5 0.1 (μmol/l) 91.8±24.2 94.0±22.3 0.8 egfr[ml/(min 1.73 m 2 )] 88.2±28.3 79.1±17.5 0.3 ( ) 1 M0/M1 7/9 11/5 0.3 E0/E1 7/9 10/6 0.5 S0/S1 2/14 6/10 0.2 T0/T1/T2 15/1/0 13/2/1 0.5 ACEI/ARB (DDD) 1.5 (0.5~4) 1.6 (0.5~2) 0.7 () 8 5 () 3 2 () 1 2 () 3 7 () 1 0 P 1A 2 IgA ACEI/ARB IgA MAP MAP (P = 0.81) 3A B egfr 3 [88.4 vs. 84.1 ml/(min 1.73m 2 )P = 0.6] 6 egfr [(-0.04±1.0) vs. (-0.3± 0.9)ml/ (min 1.73 m 2 )P = 0.4] 4 1B 2 4 T1 T2
342 2012 34 5 9 IgA [(3.8±0.4) vs. (4.1±0.3)mmol/LP = 0.03] >5.5 mmol/l 2 7 8 2 2 1 2 1 g/d; 1 (0.19~0.67 g/d) ACEI ARB 4 0.105 g/d (0.04~0.25 g/d) 9 egfr 3 egfr [13~17] IgA IgA ACEI/ARB IgA ACEI/ARB [17] [14] ACEI/ARB 3A 3B MAP MAP egfrde [18] Bianchi [16] 165 CKD GFR Chrysostomou [19] ACEI ACEI/ARB [16] CKD Meta 11 ACEI ARB [17]
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