Moriyama Takahito, Kumon Saeko, Kamiyama Takahiro, Karasawa Kazunori, Uchida Keiko, Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Women' s Medical University, Japan.
Intern Med. 2018 Jan 15;57(2):173-179. doi: 10.2169/internalmedicine.9155-17. Epub 2017 Nov 1.
Objective Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been reported to have beneficial effects in patients with IgA nephropathy (IgAN). Although DHA and EPA have different mechanisms of action, no study to date has assessed their individual actions in patients with IgAN. This study therefore analyzed the effects administering DHA in addition to EPA for the treatment of IgAN. Methods Twenty-one IgAN patients who were being treated with EPA (1,800 mg/day) were switched to EPA (1,860 mg/day) and DHA (1,500 mg/day). The changes in their clinical parameters from 6 months before to 6 months after switching treatment were analyzed. Results The triglyceride levels did not change during treatment with EPA alone, but tended to decrease-although not to a statistically significant extent-after the switch. The patients' low-density-lipoprotein cholesterol, blood pressure, proteinuria, and hematuria levels were similar before and after switching. The estimated glomerular filtration rate (eGFR) tended to decrease during EPA therapy, but became stable after switching and the median %⊿eGFR changed from -7.354% during EPA therapy to +1.26% during the 6 months after switching to EPA and DHA therapy (p=0.00132), and renal the function remained stable for another 6 months. Moreover, the median %⊿eGFR during the 6 months after switching was significantly higher in comparison to IgAN patients who were treated with EPA alone as a control (-3.26%, p=0.0361). No clinical parameters were independently associated with a stable renal function without switching to DHA/EPA. Conclusion The addition of DHA to EPA stabilized the renal function of IgAN patients, and it seemed that there were pleiotropic effects beyond the improvement of the clinical parameters.
目的 据报道，二十二碳六烯酸（DHA）和二十碳五烯酸（EPA）对IgA肾病（IgAN）患者有有益作用。尽管DHA和EPA的作用机制不同，但迄今为止尚无研究评估它们在IgAN患者中的单独作用。因此，本研究分析了在EPA基础上加用DHA治疗IgAN的效果。方法 21例正在接受EPA（1800毫克/天）治疗的IgAN患者改为接受EPA（1860毫克/天）和DHA（1500毫克/天）治疗。分析了治疗转换前6个月至转换后6个月其临床参数的变化。结果 单独使用EPA治疗期间甘油三酯水平未发生变化，但转换治疗后有下降趋势，尽管未达到统计学显著水平。转换前后患者的低密度脂蛋白胆固醇、血压、蛋白尿和血尿水平相似。估计肾小球滤过率（eGFR）在EPA治疗期间有下降趋势，但转换治疗后趋于稳定，转换后6个月的中位%⊿eGFR从EPA治疗期间的-7.354%变为转换为EPA和DHA治疗后6个月的+1.26%（p = 0.00132），并且肾功能在接下来的6个月保持稳定。此外，与仅接受EPA治疗作为对照的IgAN患者相比，转换治疗后6个月的中位%⊿eGFR显著更高（-3.26%，p = 0.0361）。没有临床参数与不转换为DHA/EPA而肾功能稳定独立相关。结论 在EPA基础上加用DHA可稳定IgAN患者的肾功能，似乎除了改善临床参数外还有多效性作用。
