Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy
Comparison between steroid pulse therapy alone and in combination with tonsillectomy for IgA nephropathy
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DOI：
10.1007/s11255-012-0251-8
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发表时间：
2013-04-01
影响因子：
2
通讯作者：
Nitta, Kosaku
中科院分区：
文献类型：
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作者：
Ochi, Ayami;Moriyama, Takahito;Nitta, Kosaku
据我们所知，没有研究比较间歇性类固醇脉冲治疗，根据Pozzi的方案，与不扁桃体切除术。在这个回顾性队列分析中，我们比较了临床表现，组织学表现，根据牛津分类，和完全缓解率（RR），根据尿蛋白排泄量定义（U-Prot < 0.3 g/g肌酐）和尿红细胞计数（U-RBC < 5/高倍视野），伊加肾病（IgAN）患者接受扁桃体切除术和类固醇脉冲治疗1年后TSP组（n = 26）或单纯激素冲击治疗组（n = 15）。通过Kaplan-Meier方法分析的U-Prot的RR在组间无差异（76.9 vs. 53.3%）。然而，TSP组中U-RBC的RR显著高于SP组（88.4 vs. 33.3%，对数秩检验; P = 0.0008）。TSP组中U-Prot和U-RBC的RR显著高于SP组（69.2 vs. 13.3%，对数秩检验; P = 0.0019）。考克斯回归分析显示，联合治疗与较高的RR相关（比值比，12.5; 95%可信区间，2.91-86.7; P = 0.0002）。治疗1年后，扁桃体切除术联合类固醇冲击治疗IgAN患者的RR高于类固醇冲击单药治疗。对肾存活率的长期影响应在进一步研究中分析。
To the best of our knowledge, no study has compared intermittent steroid pulse therapy, according to Pozzi's regimen, with versus without tonsillectomy.In this retrospective cohort analysis, we compared clinical findings, histological findings according to the Oxford classification, and complete remission rates (RR), defined in terms of urinary protein excretion (U-Prot < 0.3 g/g creatinine) and urinary red blood cell count (U-RBC < 5/high-power field), after 1 year of treatment in patients with IgA nephropathy (IgAN), who received tonsillectomy with steroid pulse therapy (TSP group, n = 26) or steroid pulse therapy alone (SP group, n = 15).The baseline clinical and histological characteristics did not differ between the two groups. The RR for U-Prot analyzed by the Kaplan-Meier method did not differ between the groups (76.9 vs. 53.3 %). However, the RR for U-RBC was significantly higher in the TSP than in the SP group (88.4 vs. 33.3 %, log-rank test; P = 0.0008). The RRs for U-Prot and U-RBC were significantly higher in the TSP group than in the SP group (69.2 vs. 13.3 %, log-rank test; P = 0.0019). Cox's regression analysis showed that combination therapy was associated with higher RR (odds ratio, 12.5; 95 % confidence interval, 2.91-86.7; P = 0.0002).Tonsillectomy combined with steroid pulse therapy achieved higher RR after 1 year of treatment, compared with steroid pulse monotherapy in patients with IgAN. The long-term effects on renal survival should be analyzed in further studies.