A CONTROLLED TRIAL OF FISH-OIL IN IGA NEPHROPATHY
A CONTROLLED TRIAL OF FISH-OIL IN IGA NEPHROPATHY
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DOI：
10.1056/nejm199411033311804
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发表时间：
1994-11-03
影响因子：
158.5
通讯作者：
HOLLEY, KE
中科院分区：
文献类型：
--
作者：
DONADIO, JV;BERGSTRALH, EJ;HOLLEY, KE
背景资料。鱼油中的n-3脂肪酸会影响二十烷类化合物和细胞因子的产生，因此有可能改变肾脏的血流动力学和炎症。目的探讨鱼油对免疫球蛋白A肾病患者免疫性肾损伤的预防作用。在一项多中心、安慰剂对照、随机试验中，我们测试了鱼油对有持续性蛋白尿的IgA肾病患者的疗效。每天服用的鱼油剂量为12克；安慰剂的剂量与橄榄油相似。对68%的基线患者的血肌酐浓度和内生肌酐清除量进行了两年的测量。主要终点是研究结束时血清肌酐浓度增加50%或更多。55名患者被分配接受鱼油治疗，51名患者接受安慰剂治疗。根据卡普兰-迈耶的估计，鱼油组中有3名患者(6%)和安慰剂组中的14名患者(33%)在治疗期间血清肌酐浓度增加了50%或更多(P=0.002)。血清肌酐浓度的年变化中位数，鱼油组为每分升0.03毫克(每升2.7微克摩尔)，安慰剂组为每升0.14毫克(每升12.4微克摩尔)。两组的蛋白尿略有减少，高血压得到控制，达到了相当的程度。4年后，安慰剂组死亡或患有终末期肾病患者的累积百分比为40%，鱼油组为10%(P=0.006)。无1例患者因不良反应而中断鱼油治疗。在IgA肾病患者中，用鱼油治疗两年可以延缓肾功能丧失的速度，
Background. The n-3 fatty acids in fish oil affect eicosanoid and cytokine production and therefore have the potential to alter renal hemodynamics and inflammation. The effects of fish oil could prevent immunologic renal injury in patients with IgA nephropathy.Methods. In a multicenter, placebo-controlled, randomized trial we tested the efficacy of fish oil in patients with IgA nephropathy who had persistent proteinuria. The daily dose of fish oil was 12 g; the placebo was a similar dose of olive oil. Serum creatinine concentrations, elevated in 68 percent of the patients at base line, and creatinine clearance were measured for two years. The primary end point was an increase of 50 percent or more in the serum creatinine concentration at the end of the study.Results. Fifty-five patients were assigned to receive fish oil, and 51 to receive placebo. According to Kaplan-Meier estimation, 3 patients (6 percent) in the fish-oil group and 14 (33 percent) in the placebo group had increases of 50 percent or more in their serum creatinine concentrations during treatment (P = 0.002). The annual median changes in the serum creatinine concentrations were 0.03 mg per deciliter (2.7 mu mol per liter) in the fish-oil group and 0.14 mg per deciliter (12.4 mu mol per liter) in the placebo group. Proteinuria was slightly reduced and hypertension was controlled to a comparable degree in both groups. The cumulative percentage of patients who died or had end-stage renal disease was 40 percent in the placebo group after four years and 10 percent in the fish-oil group (P = 0.006). No patient discontinued fish-oil treatment because of adverse effects.Conclusions. In patients with IgA nephropathy, treatment with fish oil for two years retards the rate at which renal function is lost,