Hogg Ronald J, Fitzgibbons Lisa, Atkins Carolyn, Nardelli Nancy, Bay R Curtis
St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1167-72. doi: 10.2215/CJN.02300606. Epub 2006 Sep 27.
Previous studies that have evaluated fish oil preparations in patients with IgA nephropathy (IgAN) have produced a wide range of conclusions. Proposed explanations for these discordant results have not provided a unifying hypothesis. Results from two clinical trials were analyzed to examine whether there is a dosage-dependent effect of Omacor, a purified preparation of omega-3 fatty acids, in patients with IgAN. Whether changes in the level of proteinuria and plasma phospholipid fatty acid profiles were dependent on the dose of Omacor factored by body size was determined. In a post hoc analysis of the first trial results, correlations were found between (1) phospholipid eicosapentaenoic acid (EPA)/arachidonic acid (AA) and docosahexaenoic acid (DHA)/AA ratios and the dosage of Omacor, expressed as milligrams per kilogram of body weight (r = 0.78, P < 0.001 for EPA/AA; r = 0.86, P < 0.001 for DHA/AA), (2) phospholipid EPA/AA and DHA/AA levels and percentage change in urine protein/creatinine ratio after 21 to 24 mo of therapy (r = -0.50, P = 0.02 for EPA/AA; r = -0.52, P = 0.01 for DHA/AA), and (3) dosage of Omacor per kilogram of body weight and change in proteinuria after 21 to 24 mo (r = -0.50, P = 0.02). A similar relationship was observed between urine protein/creatinine ratio and dosage of Omacor per kilogram of body weight in trial 2 (r = -0.38, P < 0.001). It is concluded from these data that the effect of Omacor on proteinuria in patients with IgAN is dosage dependent and is associated with a dosage-dependent effect of Omacor on plasma phospholipid EPA and DHA levels.
以往评估鱼油制剂对IgA肾病（IgAN）患者疗效的研究得出了广泛的结论。针对这些不一致结果提出的解释并未提供一个统一的假说。分析了两项临床试验的结果，以检验ω-3脂肪酸纯化制剂Omacor对IgAN患者是否存在剂量依赖性效应。确定蛋白尿水平和血浆磷脂脂肪酸谱的变化是否取决于按体重计算的Omacor剂量。在对第一项试验结果的事后分析中，发现了以下相关性：（1）磷脂二十碳五烯酸（EPA）/花生四烯酸（AA）和二十二碳六烯酸（DHA）/AA比值与Omacor剂量之间的相关性，以每千克体重毫克数表示（EPA/AA，r = 0.78，P < 0.001；DHA/AA，r = 0.86，P < 0.001）；（2）磷脂EPA/AA和DHA/AA水平与治疗21至24个月后尿蛋白/肌酐比值的百分比变化之间的相关性（EPA/AA，r = -0.50，P = 0.02；DHA/AA，r = -0.52，P = 0.01）；（3）每千克体重的Omacor剂量与21至24个月后蛋白尿变化之间的相关性（r = -0.50，P = 0.02）。在试验2中，尿蛋白/肌酐比值与每千克体重的Omacor剂量之间也观察到了类似的关系（r = -0.38，P < 0.001）。从这些数据得出结论，Omacor对IgAN患者蛋白尿的影响是剂量依赖性的，并且与Omacor对血浆磷脂EPA和DHA水平的剂量依赖性效应相关。
