Department of Nephrology, Shenzhen Key Laboratory of Renal, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Guangzhou, China.
The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, 518020, China.
BMC Nephrol. 2023 Mar 22;24(1):63. doi: 10.1186/s12882-023-03106-4.
Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulopathy worldwide, and lacks the effective treatment. The study was aimed to investigate the clinical efficacy of fluticasone propionate aerosol combined with angiotensin converting enzyme inhibitor / angiotensin receptor blocker (ACEI/ARB) in the treatment of IgAN.
142 patients with biopsy-proven IgAN at Shenzhen People?s hospital from June 2018 to June 2020 were enrolled. The patients were randomly divided into the supportive care plus fluticasone group and the supportive care group. The patients of the supportive care plus fluticasone group were treated with fluticasone propionate aerosol (250 ?g Bid) combined with ACEI/ARB, while the supportive care group was merely treated with ACEI/ARB. The patients were followed up at 3, 6 and 9 months after enrollment. Primary outcomes include changes in proteinuria and estimated glomerular filtration rate (eGFR).
The level of proteinuria in the supportive care plus fluticasone group was significantly lower compared with the supportive care group at 0, 3, 6 and 9 months. Meanwhile, during the follow-up period, no serious adverse events were recorded during the study in either group. However, fluticasone treatment did not alleviate the decline in eGFR.
Fluticasone propionate aerosol combined with ACEI/ARB can reduce the level of proteinuria in thetreatment of IgAN, and has no significant effects on renal function.
免疫球蛋白 A 肾病（IgAN）是全球最常见的原发性肾小球疾病，缺乏有效治疗方法。本研究旨在探讨丙酸氟替卡松气雾剂联合血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）治疗 IgAN 的临床疗效。
选取 2018 年 6 月至 2020 年 6 月在深圳市人民医院经肾活检确诊为 IgAN 的患者 142 例。将患者随机分为支持治疗加丙酸氟替卡松组和支持治疗组。支持治疗加丙酸氟替卡松组患者给予丙酸氟替卡松气雾剂（250 μg，bid）联合 ACEI/ARB 治疗，支持治疗组仅给予 ACEI/ARB 治疗。患者在入组后 3、6、9 个月进行随访。主要结局包括蛋白尿和估算肾小球滤过率（eGFR）的变化。
支持治疗加丙酸氟替卡松组患者的蛋白尿水平在 0、3、6 和 9 个月时均明显低于支持治疗组。同时，在研究期间，两组均未记录到严重不良事件。然而，丙酸氟替卡松治疗并未减轻 eGFR 的下降。
丙酸氟替卡松气雾剂联合 ACEI/ARB 可降低 IgAN 治疗中的蛋白尿水平，对肾功能无显著影响。
