摘要
目的探讨钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)对IgA肾病(IgAN)尿蛋白的影响及用药安全性。方法回顾性筛选2019年9月至2024年6月在武汉大学人民医院肾内科经肾活检诊断为IgAN且24 h尿蛋白定量为0.3~3.5 g、估算肾小球滤过率(eGFR)≥30 mL/(min·1.73m^(2))的患者。根据治疗方法分为SGLT2i联合肾素-血管紧张素系统抑制剂(RASi)组(观察组,n=22)和RASi组(对照组,n=34)。主要观察指标为6个月内尿蛋白变化,次要观察指标为24个月内eGFR斜率变化,比较两组疗效及不良反应。结果治疗6个月后,观察组与对照组患者的24 h尿蛋白定量、24 h尿蛋白较基线下降百分比均显示出随时间下降的趋势(P<0.05),但两组差异无统计学意义(P>0.05)。在治疗6个月末,观察组和对照组24 h尿蛋白定量总缓解率分别为63.64%和29.41%,两组差异有统计学意义(P<0.05)。而在末次随访时,两组24 h尿蛋白定量总缓解率分别为59.09%和47.06%,差异无统计学意义(P>0.05)。在基线24 h尿蛋白定量≥1.0 g或基线eGFR≥90 mL/(min·1.73m^(2))亚组中,治疗6个月后,观察组尿蛋白缓解程度均优于对照组(P<0.05),但末次随访时,两组差异无统计学意义(P>0.05)。观察组总eGFR斜率略低于对照组,但两组差异无统计学意义(P>0.05)。两组患者均未出现严重不良反应。结论与单用RASi相比,SGLT2i联合RASi用药可显著提高IgA肾病患者治疗6个月时的尿蛋白总缓解率,尤其是在基线24 h尿蛋白≥1.0 g或eGFR≥90 mL/(min·1.73m^(2))的患者中获益更为明确。联合治疗方案显示出延缓eGFR长期下降趋势的潜力,且未增加安全风险。
Objective To explore the effect of sodium-glucose cotransporter 2 inhibitors(SGLT2i)therapy on urinary protein in patients with IgA nephropathy(IgAN)and the safety of medication.Methods Retrospective screening was conducted for patients who were diagnosed with IgAN by renal biopsy at the Department of Nephrology,Renmin Hospital of Wuhan University from September 2019 to June 2024.Inclusion criteria included 24-hour urinary protein quantification between 0.3~3.5 g and estimated glomerular filtration rate(eGFR)≥30 mL/(min·1.73m^(2)).The patients were divided into two groups:the group of SGLT2i plus renin-angiotensin system inhibitors(RASi)(observation group,n=22)and the group of RASi only(control group,n=34).The primary outcomes were the change in urinary protein levels over 6 months.Secondary outcomes included the change in eGFR slope during the 24-month treatment period.The therapeutic effects and adverse reactions were compared.Results During the 6-month period,both the observation and control groups showed a decreasing trend with time in 24-hour urinary protein quantification and percentage reduction from baseline(P<0.05).However,there was no statistically significant difference between the two groups(P>0.05).The total remission rate of 24-hour urinary protein at the end of 6-month treatment was significantly higher in the observation group(63.64%)compared to the control group(29.41%)(P<0.05);however,at the last follow-up,there was no statistically significant difference between the two groups(59.09%vs.47.06%,P>0.05).In the subgroups with baseline 24-hour urinary protein levels≥1.0 g or baseline eGFR≥90 mL/(min·1.73m^(2)),the degree of urinary protein remission in the observation group after 6 months treatment was better than that in the control group(P<0.05),but there was no statistically significant difference at the last follow-up(P>0.05).During the 24-month observation,the total slope of eGFR in the observation group was slightly lower than that in the control group,but the difference was not statistically significant(P>0.05).No serious adverse reactions occurred in either group of patients.Conclusion Compared with RASi monotherapy,the combination of SGLT2i with RASi can significantly improve the overall remission rate of urinary protein at 6 months after treatment in patients with IgA nephropathy,with particularly pronounced benefits observed in those with baseline 24-hour urinary protein≥1.0 g or eGFR≥90 mL/(min·1.73m^(2)).Furthermore,the combination therapy demonstrates the potential to slow the long-term decline in eGFR without increasing safety risks.
作者
虎璇
陈铖
苏可
Hu Xuan;Chen Cheng;Su Ke(Blood Purification Center,the First Hospital of Kunming,Kunming 650034,China;The First Clinical School of Wuhan University.Wuhan 430060,China;Department of Nephrology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Nephrology,Wuhan Fourth Hospital,Puai Hospital,Wuhan 430030,China)
出处
《实用药物与临床》
2026年第2期102-108,共7页
Practical Pharmacy and Clinical Remedies
