Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy
Tonsillectomy has beneficial effects on remission and progression of IgA nephropathy independent of steroid therapy
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DOI：
10.1093/ndt/gfs053
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发表时间：
2012-07-01
影响因子：
6.1
通讯作者：
Imanishi, Masahito
中科院分区：
文献类型：
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作者：
Maeda, Isseki;Hayashi, Tomoshige;Imanishi, Masahito
扁桃体切除术在日本经常使用，而西方肾脏病学家则不太愿意采用扁桃体切除术来治疗 IgANaEuro 垂直杆断裂（本期 NDT） Isseki 等。报告了 200 名经活检证实 IgAN 的日本患者在肾活检后平均随访长达 7 年的结果。扁桃体切除术治疗 IgA 肾病的适应症存在争议。本研究的目的是探讨扁桃体切除术对 IgA 肾病缓解和进展的疗效。我们对 200 名活检证实的 IgA 肾病患者进行了一项单中心 7 年历史队列研究。研究结果是临床缓解（定义为连续两次就诊时尿液异常消失）、肾小球滤过率（GFR）下降（定义为较基线下降 30 GFR）以及随访期间的 GFR 斜率。200 名患者中的 70 名接受了扁桃体切除术。扁桃体切除术与临床缓解发生率增加（P < 0.01，对数秩检验）和 GFR 下降发生率降低（P < 0.01，对数秩检验）相关。调整年龄和性别后，扁桃体切除术临床缓解的风险比为 3.90（95 置信区间 2.466.18），GFR 下降的风险比为 0.14（0.021.03）。在进一步调整实验室（基线平均动脉压、GFR、24小时蛋白尿和血尿评分）、组织学（系膜评分、节段硬化或粘连、毛细血管内增殖和间质纤维化）或治疗变量（类固醇和肾素血管紧张素系统抑制剂）后，每个模型都获得了相似的结果。即使排除了 69 名接受类固醇治疗的患者，结果也没有改变。扁桃体切除组和非扁桃体切除组的 GFR 斜率分别为 0.60±3.65 和 1.64±2.59 mL/min/1.73 m(2)/年。在多元回归模型中，扁桃体切除术可防止随访期间 GFR 下降（回归系数 2.00，P < 0.01）。扁桃体切除术与 IgA 肾病的良好肾脏结局相关，即使在非类固醇治疗的患者中，在临床缓解和延迟肾功能恶化方面也是如此。
Tonsillectomy is being frequently used in Japan, while Western nephrologists are more reluctant to adopt tonsillectomy as a treatment for IgANaEuro broken vertical bar(In this issue of NDT) Isseki et al. report the outcome of 200 Japanese patients with biopsy-proven IgAN followed in mean for up to 7 years after renal biopsy.Indication of tonsillectomy in IgA nephropathy is controversial. The purpose of this study was to examine the efficacy of tonsillectomy on remission and progression of IgA nephropathy.We conducted a single-center 7-year historical cohort study in 200 patients with biopsy-proven IgA nephropathy. Study outcomes were clinical remission defined as disappearance of urine abnormalities at two consecutive visits, glomerular filtration rate (GFR) decline defined as 30 GFR decrease from baseline and GFR slope during the follow-up.Seventy of the 200 patients received tonsillectomy. Tonsillectomy was associated with increased incidence of clinical remission (P 0.01, log-rank test) and decreased incidence of GFR decline (P 0.01, log-rank test). After adjustment for age and gender, hazard ratios in tonsillectomy were 3.90 (95 confidence interval 2.466.18) for clinical remission and 0.14 (0.021.03) for GFR decline. After further adjustment for laboratory (baseline mean arterial pressure, GFR, 24-h proteinuria and hematuria score), histological (mesangial score, segmental sclerosis or adhesion, endocapillary proliferation and interstitial fibrosis) or treatment variables (steroid and reninangiotensin system inhibitors), similar results were obtained in each model. Even after exclusion of 69 steroid-treated patients, results did not change. GFR slopes in tonsillectomy and non-tonsillectomy groups were 0.60 3.65 and 1.64 2.59 mL/min/1.73 m(2)/year, respectively. In the multiple regression model, tonsillectomy prevented GFR decline during the follow-up period (regression coefficient 2.00, P 0.01).Tonsillectomy was associated with a favorable renal outcome of IgA nephropathy in terms of clinical remission and delayed renal deterioration even in non-steroid-treated patients.