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目的:回顾性分析非诺贝特治疗脂蛋白肾病的长期疗效。方法:2003年至2013年在南京军区南京总医院肾脏科肾活检确诊脂蛋白肾病者共45例,30例随访>24月,其中15例接受非诺贝特治疗(200~400mg/d)设为贝特组;15例未用贝特类药物的患者为对照组。结果:贝特组与对照组患者主要临床指标[血清肌酐(SCr)、白蛋白(Alb)和载脂蛋白E(Apo E)水平、尿蛋白定量)]基线值相当(P>0.05);治疗12、24月后,贝特组尿蛋白定量、SCr及Apo E水平显著低于对照组,Alb显著高于对照组(P值均<0.05),贝特组患者尿蛋白水平缓慢下降,SCr稳定,Alb逐渐上升;对照组尿蛋白及SCr水平逐渐升高,Alb逐渐下降。两组Apo E水平均有下降,但贝特组治疗24月后血Apo E水平对比差异显著,对照组前后比较无统计学差异。生存分析提示贝特组肌酐倍增的中位时间为71.62月,对照组为34.78月,贝特组预后优于对照组,两者相比差异显著。结论:非诺贝特可降低脂蛋白肾病患者尿蛋白及血Apo E水平,延缓肾功能不全的进展。
Objective: To retrospectively analyze the long-term effect of fenofibrate in the treatment of lipoprotein nephropathy. Methods: From 2003 to 2013, 45 cases of lipoprotein nephropathy were diagnosed by renal biopsy in Nanjing General Hospital of Nanjing Military Region. 30 cases were followed up for 24 months. 15 cases were treated with fenofibrate (200-400mg / d) For the fibrate group; 15 patients without fibrate drugs for the control group. Results: The main clinical parameters (serum creatinine (SCr), albumin (Alb) and ApoE level, urine protein quantitation in the fibrate group and control group) were comparable (P> 0.05) After 12 and 24 months, the urinary protein, SCr and Apo E levels in the fibrate group were significantly lower than those in the control group (all P <0.05), the proteinuria of the fibrate group was slowly decreased and the SCr was stable , Alb gradually increased; control group, urinary protein and SCr levels gradually increased, Alb gradually decreased. The Apo E levels decreased in both groups, but there was no significant difference in blood Apo E levels between the two groups after 24 months of treatment. There was no significant difference between the two groups before and after treatment. Survival analysis showed that the median time to creatinine doubling in the fibrate group was 71.62 months, while that in the control group was 34.78 months. The prognosis of the fibrate group was better than that of the control group. There was significant difference between the two groups. Conclusion: Fenofibrate can reduce urinary protein and blood Apo E levels in patients with lipoprotein nephropathy and delay the progression of renal insufficiency.