Combined Immunosuppressive Treatment May Improve Short-Term Renal Outcomes in Chinese Patients with Advanced IgA Nephropathy
Combined Immunosuppressive Treatment May Improve Short-Term Renal Outcomes in Chinese Patients with Advanced IgA Nephropathy
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DOI：
10.1159/000492592
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Qin, Wei
中科院分区：
文献类型：
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作者：
Tan, Li;Tang, Yi;Qin, Wei
背景/目标：估计肾小球滤过率（eGFR）低于45 mL/min/1.73 m2的晚期免疫球蛋白A肾病（IgAN）患者的治疗仍然不一致。本研究的目的是比较皮质类固醇和免疫抑制剂治疗这些患者的效果。研究方法：在2002年12月30日至2016年6月30日期间，共研究了201例晚期IgAN成人患者（eGFR < 45 mL/min/1.73 m（2），活检时蛋白尿>1 g/24 h），分为支持治疗（SC）组、单纯类固醇（CS）组和类固醇加免疫抑制剂（IT）组。主要终点是eGFR下降50%和/或终末期肾病（ESRD：eGFR < 15 mL/min/1.73 m（2）或维持肾脏替代治疗）的联合终点。对治疗的反应包括完全缓解（CR：尿蛋白排泄< 0.5 g/24 h，eGFR降低小于10%基线）、部分缓解（PR：蛋白尿降低> 50%基线，eGFR降低小于10%基线）、无反应（NR：蛋白尿降低< 50%基线，或eGFR降低>10%基线）和ESRD。进行Kaplan-Meier和考克斯比例风险分析。结果如下：在随访期间（37.2 ± 22.7个月），SC组、CS组和IT组分别有6.8%、25.0%和38.0%的患者达到CR或PR，而这三组分别有78.4%、62.5%和49.3%的患者达到主要终点（p < 0.001）。SC和联合免疫抑制治疗组（CS和IT组）的3年肾存活率分别为33.8%和51.2%（p = 0.02），5年肾存活率分别为12.2%和21.3%（p = 0.1）。多因素考克斯回归分析显示，高血压（HR = 2.44，95% CI 1.51-3.95; p < 0.001），Scr（HR = 1.01，95% CI 1.00-1.01; p < 0.001）、T1-T2病变（HR = 1.99，95% CI 1.35-2.93; p = 0.001）是肾脏预后不良的独立指标。结论：与支持性治疗相比，免疫抑制治疗（CS和IT治疗）可改善晚期IgAN患者的短期肾脏结局。(C)2018作者（S）由S发布。Karger AG，巴塞尔
Background/Aims: Treatment of advanced Immunoglobulin A nephropathy (IgAN) patients with estimated glomerular filtration rate (eGFR) below 45 mL/min per 1.73 m(2) remains inconsistent. The aim of this study is to compare the effects of corticosteroid and immunosuppressant therapies among these patients. Methods: A total of 201 adult patients with advanced IgAN (eGFR < 45 mL/min/1.73 m(2) and proteinuria >1 g/24h at biopsy) grouped into supportive care (SC), steroids alone (CS), and steroids plus immunosuppressant (IT) groups, were investigated between 30th December 2002 and 30th June 2016. The primary endpoint was the combined endpoint of a 50% decline in eGFR and/or end stage renal disease (ESRD: eGFR < 15 mL/min/1.73 m(2) or maintenance renal replacement treatment). Responses to therapy included complete remission (CR: urinary protein excretion < 0.5 g/24h, with eGFR decrease less than 10% baseline), partial remission (PR: proteinuria decrease by > 50% baseline, with eGFR decrease less than 10% baseline), no response (NR: proteinuria decrease < 50% baseline, or eGFR decrease >10% baseline) and ESRD. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: During the follow-up period (37.2 +/- 22.7 months), 6.8% patients in SC group, 25.0% in CS group, and 38.0% in IT group achieved CR or PR, while 78.4%, 62.5% and 49.3% patients in these 3 groups reached primary endpoint respectively (p < 0.001). Three-year renal survival rates in SC and combined immunosuppressive treatment groups (CS and IT groups) were 33.8% vs 51.2% (p = 0.02), and 5-year renal survival rates were 12.2% vs 21.3% (p = 0.1) respectively. Multivariate Cox regression analysis showed that hypertension (HR = 2.44, 95% CI 1.51-3.95; p < 0.001), Scr (HR = 1.01, 95% CI 1.00-1.01; p < 0.001), T1-T2 lesion (HR = 1.99, 95% CI 1.35-2.93; p = 0.001) were independent indicators of poor renal outcome. Conclusion: Immunosuppressive treatment (CS and IT therapy) may improve short-term renal outcome compared with supportive treatment in advanced IgAN patients. (C) 2018 The Author(s) Published by S. Karger AG, Basel