背景:扁桃体切除术联合类固醇脉冲(TSP)治疗IgA肾病(IgAN)的效果鲜为人知。因此,我们检查了TSP治疗对IgAN肾脏结局的影响,日本全国队列研究。
方法:在2002年至2004年之间,将632例诊断为蛋白尿≥0.5g/天的IgAN患者分为三组,轻度(0.50-0.99g/天;n=264),中度(1.00-1.99克/天,n=216),或严重(≥2.00g/天;n=153)。比较3组患者TSP治疗后肾功能下降和尿缓解情况,皮质类固醇(ST)治疗,或保守治疗,平均随访6.2±3.3年。在ST和保守治疗组中,分别有10.6%和5.9%的患者接受了扁桃体切除术。
结果:最终观察时,TSP治疗组的尿缓解率明显高于ST或保守治疗组(轻度蛋白尿:64%,43%,和41%;中度蛋白尿:51%,45%,和28%;严重的蛋白尿:48%,30%,22%,分别)。相比之下,TSP治疗组血清肌酐增加50%的比率较低,比ST或保守治疗(轻度蛋白尿:2.1%,10.1%和16.7%;中度蛋白尿:4.8%,8.8%和27.7%;重度蛋白尿:12.0%,28.9%和43.1%,分别)。在多变量分析中,与保守治疗相比,在中度和重度蛋白尿组中,TSP治疗显着阻止了血清肌酐水平增加50%(风险比,分别为0.12和0.22)。
结论:TSP显著增加轻度至中度尿蛋白水平的IgAN患者的蛋白尿消失和尿缓解率。它还可以减少中度至重度尿蛋白水平患者的肾功能下降。
BACKGROUND: The effects of tonsillectomy combined with steroid pulse (TSP) therapy for IgA nephropathy (IgAN) are little known. Therefore, we examined the effects of TSP therapy on the kidney outcomes of IgAN in a large, nationwide cohort study in Japan.
METHODS: Between 2002 and 2004, 632 IgAN patients with ≥ 0.5 g/day proteinuria at diagnosis were divided into three groups with mild (0.50-0.99 g/day; n = 264), moderate (1.00-1.99 g/day, n = 216), or severe (≥ 2.00 g/day; n = 153). Decline in kidney function and urinary remission were compared among the three groups after TSP therapy, corticosteroid (ST) therapy, or conservative therapy during a mean follow-up of 6.2 ± 3.3 years. 10.6% and 5.9% of patients in the ST and conservative therapy group underwent tonsillectomy.
RESULTS: The rate of urinary remission at the final observation was significantly higher in the TSP therapy group than in the ST or conservative therapy groups (mild proteinuria: 64%, 43%, and 41%; moderate proteinuria: 51%, 45%, and 28%; severe proteinuria: 48%, 30%, and 22%, respectively). In contrast, the rate of a 50% increase in serum creatinine was lower in groups TSP therapy, than ST or conservative therapy (mild proteinuria: 2.1%, 10.1% and 16.7%; moderate proteinuria: 4.8%, 8.8% and 27.7%; severe proteinuria: 12.0%, 28.9% and 43.1%, respectively). In multivariate analysis, TSP therapy significantly prevented a 50% increase in serum creatinine levels compared with conservative therapy in groups with moderate and severe proteinuria (hazard ratio, 0.12 and 0.22, respectively).
CONCLUSIONS: TSP significantly increased the rate of proteinuria disappearance and urinary remission in IgAN patients with mild-to-moderate urinary protein levels. It may also reduce the decline in kidney function in patients with moderate-to-severe urinary protein levels.