Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy
Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy
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DOI：
10.1053/ajkd.2001.27690
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发表时间：
2001-10-01
影响因子：
13.2
通讯作者：
Taguma, Y
中科院分区：
文献类型：
--
作者：
Hotta, O;Miyazaki, M;Taguma, Y
我们对 1977 年至 1995 年间 329 名免疫球蛋白 A (IgA) 肾病患者的肾脏结局进行了回顾性调查，观察期超过 36 个月（82.3 +/- 38.2 个月）。通过 Kaplan-Meier 分析和 Cox 回归模型评估临床缓解、肾脏进展和协变量的影响。 329 名患者中有 157 名（48%）尿路异常消失（临床缓解）。在观察期间，这 157 名患者均未出现进行性恶化（定义为血清肌酐 (Scr) 水平较基线增加 50%）。相反，在没有临床缓解的患者中，Kaplan-Meier 估计的 10 年进行性恶化的概率为 21% +/- 5%。在具有13个独立协变量的多变量Cox回归模型中，初始Scr水平、组织学评分、扁桃体切除术和大剂量甲泼尼龙治疗对临床缓解有显着影响，而蛋白尿、年龄、性别、血尿水平、血压、常规类固醇治疗、血管紧张素转换酶抑制剂治疗和环磷酰胺治疗没有显着影响。这些发现表明，旨在实现临床缓解的干预措施已提供了令人鼓舞的结果，适用于 IgA 肾病患者的治疗。 (C) 2001 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
We conducted a retrospective investigation of renal outcome in 329 patients with immunoglobulin A (IgA) nephropathy with an observation period longer than 36 months (82.3 +/- 38.2 months) in our renal unit between 1977 and 1995. Clinical remission, renal progression, and the impact of covariates were estimated by Kaplan-Meier analysis and a Cox regression model. In 157 of 329 patients (48%), disappearance of urinary abnormalities (clinical remission) was obtained. None of these 157 patients showed progressive deterioration, defined as a 50% Increase in serum creatinine (Scr) level from baseline, during the observation period. Conversely, in patients without clinical remission, the Kaplan-Meier estimate of probability of progressive deterioration was 21% +/- 5% at 10 years. In the multivariate Cox regression model with 13 independent covariates, initial Scr level, histological score, tonsillectomy, and high-dose methylprednisolone therapy had a significant impact on clinical remission, whereas proteinuria, age, sex, levels of hematuria, blood pressure, conventional steroid therapy, angiotensin-converting enzyme inhibitor therapy, and cyclophosphamide therapy had no significant effect. These findings Indicate that interventions aimed at achieving clinical remission have provided encouraging results applicable to managing patients with IgA nephropathy. (C) 2001 by the National Kidney Foundation, Inc.