Severe Adverse Effects Associated With Corticosteroid Treatment in Patients With IgA Nephropathy.
Severe Adverse Effects Associated With Corticosteroid Treatment in Patients With IgA Nephropathy.
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IgA 肾病患者与皮质类固醇治疗相关的严重不良反应
DOI：
10.1016/j.ekir.2017.02.003
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发表时间：
2017-07
影响因子：
6
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Cai Q;Xie X;Wang J;Shi S;Liu L;Chen Y;Lv J;Zhang H
关于IgAN人群中皮质类固醇使用者发生SAEs风险的数据很少。我们描述了一个中国队列中与皮质类固醇相关的SAEs的患病率和危险因素。2003 - 2014年，我院肾中心共随访1034例IgAN患者。注意皮质类固醇使用的流行率和皮质类固醇相关的SAEs。采用Logistic回归方法寻找皮质类固醇使用者发生急性脑损伤的危险因素。在369例接受类固醇治疗的患者中，46例（12.5%）患者发生了58起SAEs事件，而未使用皮质类固醇的患者中只有18例（2.7%）发生了SAEs （OR: 5.45; 95% CI: 3.07-9.68; P < 0.001）。SAEs包括糖尿病（n = 19, 5.1%）、严重或致死性感染（n = 18, 4.9%）、股骨头坏死或骨折（n = 6, 1.6%）、心脑血管疾病（n = 4, 1.1%）、白内障（n = 3, 0.8%）和胃肠道出血（n = 1, 0.3%）。多变量logistic回归分析显示，高龄（OR: 1.05; 95% CI: 1.02-1.07; P < 0.001）和高血压（OR: 1.04; 95% CI: 1.01-1.06; P = 0.009）是皮质类固醇相关SAEs的危险因素。肾功能受损（估计GFR: OR: 0.98; 95% CI: 0.96-0.99; P = 0.036）是严重感染的危险因素。皮质类固醇的累积剂量未被确定为SAEs的危险因素（OR: 1.09; 95% CI: 0.91-1.30; P = 0.365）。使用皮质类固醇与IgAN患者发生SAEs的高风险相关，特别是那些年龄较大、有高血压或肾功能受损的患者。目前关于IgAN中皮质类固醇治疗方案的指南应在安全性方面进行审查。
Few data are available on the risk of SAEs in corticosteroid users in IgAN populations. We describe the prevalence and risk factors of corticosteroid-related SAEs in a Chinese cohort. A total of 1034 IgAN patients were followed up in our renal center from 2003 to 2014. Prevalence of corticosteroid use and corticosteroid-related SAEs were noted. Logistic regression was used to search for risk factors of SAEs in corticosteroid users. Of the 369 patients with steroids therapy, 46 patients (12.5%) with 58 events suffered SAEs, whereas only 18 patients (2.7%) without corticosteroids suffered SAEs (OR: 5.45; 95% CI: 3.07–9.68; P < 0.001). SAEs included diabetes mellitus (n = 19, 5.1%), severe or fatal infection (n = 18, 4.9%), osteonecrosis of the femoral head or bone fracture (n = 6, 1.6%), cardiocerebral vascular disease (n = 4, 1.1%), cataract (n = 3, 0.8%), and gastrointestinal hemorrhage (n = 1, 0.3%). Multivariable logistic regression analysis revealed that advanced age (OR: 1.05; 95% CI: 1.02–1.07; P < 0.001) and hypertension (OR: 1.04; 95% CI: 1.01–1.06; P = 0.009) were risk factors for corticosteroid-related SAEs. Impaired kidney function (estimated GFR: OR: O.98; 95% CI: 0.96–0.99; P = 0.036) was a risk factor for severe infection. Accumulated dosages of corticosteroids were not identified as a risk factor of SAEs (OR: 1.09; 95% CI: 0.91–1.30; P = 0.365). Corticosteroid use is associated with a high risk of SAEs in IgAN patients, especially those who are older, have hypertension, or impaired renal function. Current guidelines on corticosteroid regimens in IgAN should be reviewed with regard to safety.
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影响因子：
3.7
作者：
Moriyama T;Tanaka K;Iwasaki C;Oshima Y;Ochi A;Kataoka H;Itabashi M;Takei T;Uchida K;Nitta K
通讯作者：
Nitta K
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影响因子：
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