Chen Ping-Min, Lai Tai-Shuan, Chen Ping-Yu, Lai Chun-Fu, Wu Vincent, Chiang Wen-Chih, Chen Yung-Ming, Wu Kwan-Dun, Tsai Tun-Jun
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
J Formos Med Assoc. 2014 Apr;113(4):219-26. doi: 10.1016/j.jfma.2014.01.002. Epub 2014 Feb 7.
BACKGROUND/PURPOSE: Several studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD.
A single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)<1 g/g] and higher (UPCR ≥ 1 g/g) proteinuria subgroups.
There was no between-groups difference regarding mortality and cardiovascular events. Addition of pentoxifylline showed a better renal outcome (p = 0.03). The protective effect of add-on pentoxifylline was demonstrated in the higher proteinuria subgroup (p = 0.005). In the multivariate Cox regression model, pentoxifylline use also showed a better renal outcome [hazard ratio (HR): 0.705; 95% confidence interval (CI): 0.498-0.997; p = 0.048]. This effect was more prominent in the higher proteinuria subgroup (HR: 0.602; 95% CI: 0.413-0.877; p = 0.008).
In the advanced stages of CKD, patients treated with a combination of pentoxifylline and ACEI or ARB had a better renal outcome than those treated with ACEI or ARB alone. This effect was more prominent in the higher proteinuria subgroup. More large randomized control trials are needed to provide concrete evidence of the add-on effect of pentoxifylline.
背景/目的：多项研究已表明己酮可可碱在慢性肾脏病（CKD）治疗中的肾脏保护作用。本研究旨在探讨在CKD治疗中，将己酮可可碱与血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）联合使用是否能增加获益。
进行了一项单中心回顾性分析。共纳入661例接受ACEI或ARB治疗的3B - 5期CKD患者。将患者分为己酮可可碱使用组和未使用己酮可可碱组。比较两组的肾脏生存分析。通过将患者分为低蛋白尿亚组[尿蛋白与肌酐比值（UPCR）<1 g/g]和高蛋白尿亚组（UPCR≥1 g/g）进行亚组分析。
两组在死亡率和心血管事件方面无差异。加用己酮可可碱显示出更好的肾脏结局（p = 0.03）。在高蛋白尿亚组中，加用己酮可可碱的保护作用得到证实（p = 0.005）。在多变量Cox回归模型中，使用己酮可可碱也显示出更好的肾脏结局[风险比（HR）：0.705；95%置信区间（CI）：0.498 - 0.997；p = 0.048]。在高蛋白尿亚组中这种效果更显著（HR：0.602；95% CI：0.413 - 0.877；p = 0.008）。
在CKD晚期，己酮可可碱与ACEI或ARB联合治疗的患者比单独使用ACEI或ARB治疗的患者有更好的肾脏结局。这种效果在高蛋白尿亚组中更显著。需要更多大型随机对照试验来提供己酮可可碱附加作用的确切证据。
