Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy
Beneficial effects of ACTH on the serum lipoprotein profile and glomerular function in patients with membranous nephropathy
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DOI：
10.1046/j.1523-1755.1999.00675.x
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发表时间：
1999-10-01
影响因子：
19.6
通讯作者：
Arnadottir, M
中科院分区：
文献类型：
--
作者：
Berg, AL;Nilsson-Ehle, P;Arnadottir, M
背景资料。以往的研究表明，短期应用促肾上腺皮质激素(ACTH)具有强烈且快速的降脂效果。在这项肾病合并特发性膜性肾病的长期研究中，观察了ACTH对血清脂蛋白和肾小球功能的影响以及量效关系。14例患者在56天内以递增剂量肌肉注射ACTH。分析两组血脂、脂蛋白、载脂蛋白浓度及肾小球功能指标，并记录不良反应。在估计的最佳剂量下，5名严重类固醇耐药肾病综合征患者继续接受ACTH治疗。5例患者总疗程为12个月，停药后随访时间为18个月。考虑到统计学上显著的疗效和轻微的副作用，ACTH的最佳剂量估计为每周2次，每次1 mg。在该剂量下，血清胆固醇、甘油三酯、载脂蛋白B和脂蛋白(A)的浓度下降了30%到60%，而高密度脂蛋白胆固醇和载脂蛋白AI的浓度上升了30%到40%。此外，尿白蛋白排泄量减少90%，肾小球滤过率增加25%。当ACTH在持续治疗56天后停止治疗时，所有病例都观察到恶化。然而，5名恢复ACTH治疗的患者在停止治疗18个月后仍处于缓解状态。在患有特发性膜性肾病的肾病患者中，每周两次使用ACTH 1 mg治疗可显著改善血清脂蛋白模式和肾小球功能。
Background. Previous studies have shown that short-term treatment with adrenocorticotrophic hormone (ACTH) has a strong and rapid lipid-lowering effect. In this long-term study of nephrotic patients with idiopathic membranous nephropathy, the influence of ACTH on the serum lipoprotein profile and glomerular function as well as the dose-effect relationship was investigated.Methods. Fourteen patients received ACTH intramuscularly at increasing doses during 56 days. Serum concentrations of lipids, lipoproteins, and apolipoproteins as well as variables of glomerular function were analyzed, and the side-effects were recorded. ACTH treatment, in the estimated optimal dosage, was then continued in five patients with severe steroid-resistant nephrotic syndrome. In these five patients, the total treatment period was 12 months, and the follow-up time after discontinuing treatment was 18 months.Results. Taking both the statistically significant therapeutic effects and the modest side-effects into consideration, the optimal dosage of ACTH was estimated to be 1 mg twice per week. At that dose, reductions by 30 to 60% in the serum concentrations of cholesterol, triglycerides, apolipoprotein B, and lipoprotein(a) were observed, whereas the serum concentrations of high-density lipoprotein cholesterol and apolipoprotein AI rose by 30 to 40%. In addition, the urinary albumin excretion decreased by 90%, and the glomerular filtration rate increased by 25%. Deterioration was observed in all cases when ACTH was discontinued after a treatment duration of 56 days. However, the five patients in whom ACTH therapy was resumed were still in remission 18 months after discontinuance of treatment.Conclusions. In nephrotic patients with idiopathic membranous nephropathy, treatment with ACTH 1 mg twice per week was associated with significant long-term improvements in serum lipoprotein pattern and glomerular function.