Tonsillectomy for IgA Nephropathy: A Meta-analysis
Tonsillectomy for IgA Nephropathy: A Meta-analysis
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DOI：
10.1053/j.ajkd.2014.06.036
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发表时间：
2015-01-01
影响因子：
13.2
通讯作者：
Li, Xiao-li
中科院分区：
文献类型：
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作者：
Liu, Lin-lin;Wang, Li-ning;Li, Xiao-li
背景：扁桃体切除术治疗免疫球蛋白 A 肾病 (IgAN) 的疗效仍存在争议。我们的荟萃分析旨在调查其作为辅助或独立治疗的功效。研究设计：使用 PubMed、EMBASE 和 Cochrane 对照试验中心注册库对前瞻性和回顾性研究进行荟萃分析。背景和人群：接受或不接受扁桃体切除术治疗的 IgAN 患者。研究选择标准：比较 IgAN 患者临床缓解或终末期肾病 (ESRD) 的研究 有或没有扁桃体切除术。干预：扁桃体切除术。结果：临床缓解和终末期肾病。结果：纳入了 14 项研究（1,794 名患者），并应用了随机效应模型。扁桃体切除术临床缓解的几率显着更高（10 项研究，1,431 名患者；汇总 OR，3.40；95% CI，2.58-4.48；P < 0.001）。排除肾素-血管紧张素系统抑制剂影响的敏感性分析得出了一致的结果（6 项研究，671 名患者；缓解的汇总 OR，2.80；95% CI，1.91-4.09；P < 0.001）。在缓解结果的亚组分析中，扁桃体切除术加类固醇脉冲治疗优于单独类固醇脉冲治疗（7项研究，783名患者；汇总OR，3.15；95% CI，1.99-5.01；P < 0.001），扁桃体切除术加常规类固醇治疗优于单独常规类固醇治疗（2项研究，159名患者；合并OR，4.13；95% CI， 1.23-13.94； P = 0.02）。扁桃体切除术优于一般治疗（3 项研究，187 名患者；缓解的汇总 OR，2.21；95% CI，1.20-4.05；P = 0.01）。此外，扁桃体切除术与 ESRD 几率降低相关（9 项研究，873 名患者；汇总 OR，0.25；95% CI，0.12-0.52；P < 0.001）。 2 项敏感性分析（其中一项排除了随访时间少于 5 年的研究，另一项排除了肾素-血管紧张素系统抑制剂的混杂效应）得出了几乎相同的 ESRD 风险降低效果（6 项研究，691 名患者；汇总 OR，0.20；95% CI，0.11-0.36；P < 0.001；6 项研究，547 名患者；汇总 OR， 0.24；95%置信区间， 0.14-0.44； P < 0.001）。局限性：大多数纳入的研究都是回顾性队列研究；我们无法对潜在的混杂变量进行统一调整。结论：作为辅助或独立治疗，扁桃体切除术可能会引起 IgAN 患者的临床缓解并降低 ESRD 发生率。 (C) 2014 年，国家肾脏基金会，Inc.
Background: The efficacy of tonsillectomy in immunoglobulin A nephropathy (IgAN) remains controversial. Our meta-analysis was intended to investigate its efficacy as an adjunct or independent treatment.Study Design: Meta-analysis of prospective and retrospective studies using PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials.Setting & Population: Patients with IgAN treated with or without tonsillectomy.Selection Criteria for Studies: Studies that compared clinical remission or end-stage renal disease (ESRD) in patients with IgAN with or without tonsillectomy.Intervention: Tonsillectomy.Outcomes: Clinical remission and ESRD.Results: 14 studies (1,794 patients) were included and a random-effects model was applied. There were significantly greater odds of clinical remission with tonsillectomy (10 studies, 1,431 patients; pooled OR, 3.40; 95% CI, 2.58-4.48; P < 0.001). Sensitivity analysis to exclude the effects of renin-angiotensin system inhibitors yielded consistent results (6 studies, 671 patients; pooled OR for remission, 2.80; 95% CI, 1.91-4.09; P < 0.001). In subgroup analysis of the remission outcome, tonsillectomy plus steroid pulse therapy was superior to steroid pulse therapy alone (7 studies, 783 patients; pooled OR, 3.15; 95% CI, 1.99-5.01; P < 0.001), and tonsillectomy plus conventional steroid therapy was superior to conventional steroid therapy alone (2 studies, 159 patients; pooled OR, 4.13; 95% CI, 1.23-13.94; P = 0.02). Tonsillectomy was superior to general treatment (3 studies, 187 patients; pooled OR for remission, 2.21; 95% CI, 1.20-4.05; P = 0.01). In addition, tonsillectomy was associated with decreased odds of ESRD (9 studies, 873 patients; pooled OR, 0.25; 95% CI, 0.12-0.52; P < 0.001). 2 sensitivity analyses, one excluding studies with less than 5 years' follow-up and another excluding the confounding effect of renin-angiotensin system inhibitors, yielded nearly the same reduction in ESRD risk (6 studies, 691 patients; pooled OR, 0.20; 95% CI, 0.11-0.36; P < 0.001; and 6 studies, 547 patients; pooled OR, 0.24; 95% CI, 0.14-0.44; P < 0.001).Limitations: Most included studies were retrospective cohort studies; we were unable to adjust uniformly for potential confounding variables.Conclusions: As adjunct or independent therapy, tonsillectomy may induce clinical remission and reduce the rates of ESRD in patients with IgAN. (C) 2014 by the National Kidney Foundation, Inc.