Tác động của atorvastatin đối với rối loạn lipid máu và độ dày lớp cận trong động mạch ở trẻ em mắc hội chứng thận hư kháng trị: một thử nghiệm lâm sàng ngẫu nhiên có đối chứng

Springer Science and Business Media LLC - Tập 33 - Trang 2299-2309 - 2018
Pankaj Hari1, Priyanka Khandelwal1, Amit Satpathy1, Smriti Hari1, Ranjeet Thergaonkar1, R Lakshmy2, Aditi Sinha1, Arvind Bagga1
1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
2Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India

Tóm tắt

Rối loạn lipid máu là một yếu tố nguy cơ tim mạch quan trọng trong hội chứng thận hư kháng steroid (SRNS). Hiệu quả của statin trong điều trị tăng lipid máu ở trẻ em mắc SRNS chưa rõ ràng. Thử nghiệm lâm sàng triển vọng, ngẫu nhiên, mù đôi, có đối chứng giả dược này đã tuyển chọn 30 bệnh nhân mắc SRNS, tuổi từ 5-18 tối, với nồng độ cholesterol lipoprotein mật độ thấp trong huyết thanh (LDL-C) từ 130 đến 300 mg/dl, để nhận một liều cố định của atorvastatin (n = 15, 10 mg/ngày) hoặc giả dược (n = 15) thông qua phương pháp phân bổ ngẫu nhiên theo khối với tỷ lệ 1:1. Kết quả chính là sự thay đổi nồng độ LDL-C trong huyết thanh sau 12 tháng. Sự thay đổi nồng độ của các fractions lipid khác, độ dày lớp cận trong động mạch (cIMT), độ giãn mạch do dòng chảy (FMD) của động mạch cánh tay và các sự kiện bất lợi cũng được đánh giá. Cuối cùng, sau 12 tháng, atorvastatin không vượt trội hơn giả dược trong việc giảm nồng độ LDL-C, tỷ lệ phần trăm giảm trung bình là 15,8% và 9,5% tương ứng ở nhóm atorvastatin và nhóm giả dược (n = 14 ở mỗi nhóm; P = 0,40). Mức apolipoprotein B giảm đáng kể với atorvastatin trong phân tích theo ý định điều trị đã điều chỉnh (P = 0,01) nhưng không trong phân tích theo quy trình. Không có tác động đáng kể nào đối với các fractions lipid khác, cIMT và FMD. Các sự kiện bất lợi tương tự giữa các nhóm. Sự thay đổi nồng độ albumin trong huyết thanh liên quan nghịch với sự thay đổi nồng độ LDL-C trong huyết thanh, cholesterol lipoprotein mật độ rất thấp, cholesterol toàn phần, triglyceride và apolipoprotein B (P < 0,001), bất kể có dùng atorvastatin hay không, tuổi tác, giới tính, chỉ số khối cơ thể và nồng độ creatinine trong huyết thanh. Atorvastatin, được dùng với liều cố định hàng ngày 10 mg, không có lợi trong việc giảm mức lipid ở trẻ em mắc SRNS; sự tăng cường mức albumin trong huyết thanh liên quan đến sự cải thiện ở rối loạn lipid máu.

Từ khóa

#hội chứng thận hư kháng trị #atorvastatin #rối loạn lipid máu #trẻ em #thử nghiệm lâm sàng ngẫu nhiên

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