Renal outcome after tonsillectomy plus corticosteroid pulse therapy in patients with immunoglobulin A nephropathy: results of a multicenter cohort study
Renal outcome after tonsillectomy plus corticosteroid pulse therapy in patients with immunoglobulin A nephropathy: results of a multicenter cohort study
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DOI：
10.1007/s10157-015-1194-z
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发表时间：
2016-08-01
影响因子：
2.3
通讯作者：
Yamagata, Kunihiro
中科院分区：
文献类型：
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作者：
Hoshino, Junichi;Fujii, Takayuki;Yamagata, Kunihiro
除了肾素-血管紧张素系统抑制剂（RAS），糖皮质激素被推荐用于免疫球蛋白A肾病（IgAN）伴ae 1 g/天蛋白尿的患者。据报道，扁桃体切除术加皮质类固醇脉冲治疗（TSP）比单纯口服皮质类固醇（OS）或类固醇脉冲（SP）治疗更能有效地缓解IgAN，但这一点尚未得到证实。因此，本研究比较了TSP、皮质类固醇治疗和RAS对多中心、大规模、长期队列的影响。1127例活检证实的IgAN慢性肾病（CKD）患者，G1-3，1981年3月至2013年12月在我们医院接受TSP（n = 209）、SP（n = 103）、OS（n = 300）或RAS治疗，单独治疗组（n = 515）随访至终末期肾病（ESRD）或死亡，通过治疗和蛋白尿水平比较肾存活率。校正性别、年龄、BMI、eGFR、白蛋白、蛋白尿、血尿、血压、药物和肾活检年份后，进行倾向评分匹配分析，以TSP为参照，SP、OS和RAS的总体HR分别为1.33（0.44-4.04）、3.56（1.45-8.71）和3.64（1.48-8.96），尿蛋白ae 1.0 g/gCre时，HR分别为2.99（0.71-12.54）、5.04（1.44-17.67）和7.23（1.98-26.40）;蛋白尿< 1.0 g/gCre，0.42（0.04-4.89）、3.24（0.79-13.30）和2.05（0.52-8.05）; CKD G3患者为0.37（0.10-1.41）、2.14（0.77-5.94）和2.03（0.72-5.72）。在病理分级和/或倾向评分匹配模型中观察到类似的结果，在CKD G1-2中，蛋白尿ae 1.0 g/gCre的IgAN患者中TSP可能比其他治疗更好地降低ESRD的风险，而在CKD G3或蛋白尿< 1.0 g/gCre的IgAN患者中，结果与SP相似。
In addition to renin-angiotensin system inhibition (RAS), corticosteroids are recommended for patients who have immunoglobulin A nephropathy (IgAN) with ae 1 g/day proteinuria. Tonsillectomy plus corticosteroid pulse therapy (TSP) had been reported as more effective in producing clinical remission of IgAN than just oral-corticosteroid (OS) or steroid-pulse (SP) therapy-but that remained unconfirmed. Accordingly, this study compared the effects of TSP, corticosteroid therapies, and RAS on a multicenter, large-scale, long-term cohort.1127 biopsy-proven IgAN patients with chronic kidney disease (CKD), G1-3, treated in our hospitals March 1981-December 2013 with TSP (n = 209), SP (n = 103), OS (n = 300), or RAS, alone (n = 515), were followed until end-stage renal disease (ESRD) or death, renal survival compared by treatment and proteinuria level. Hazard ratios (HRs) of ESRD were analyzed after adjusting for sex, age, BMI, eGFR, albumin, proteinuria, hematuria, blood pressure, medications, and renal-biopsy year, with propensity-score-matched analyses performed.With TSP as referent, the overall HRs of SP, OS, and RAS were, respectively, 1.33 (0.44-4.04), 3.56 (1.45-8.71), and 3.64 (1.48-8.96); with proteinuria ae 1.0 g/gCre, respective HRs were 2.99 (0.71-12.54), 5.04 (1.44-17.67), and 7.23 (1.98-26.40); with proteinuria < 1.0 g/gCre, 0.42 (0.04-4.89), 3.24 (0.79-13.30), and 2.05 (0.52-8.05); and for patients with CKD G3, 0.37 (0.10-1.41), 2.14 (0.77-5.94), and 2.03 (0.72-5.72). Similar results were observed in models including pathological grading and/or propensity-score matching.TSP may decrease the risk of ESRD in IgAN patients better than other therapies in CKD G1-2, with proteinuria ae 1.0 g/gCre, while outcome was similar to SP in CKD G3, or with proteinuria < 1.0 g/gCre.