The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy
The efficacy of tonsillectomy on long-term renal survival in patients with IgA nephropathy
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DOI：
10.1046/j.1523-1755.2003.00935.x
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发表时间：
2003-05-01
影响因子：
19.6
通讯作者：
Gejyo, F
中科院分区：
文献类型：
--
作者：
Xie, YS;Nishi, S;Gejyo, F
背景。到目前为止，关于扁桃体切除术对特发性免疫球蛋白A肾病（IgAN）患者长期肾生存的临床疗效的信息还很少。为了探讨扁桃体切除术对肾脏长期生存的影响，我们回顾了1973年至1980年118例特发性活检诊断为IgAN的患者的临床病程。其中，48名患者接受了扁桃体切除术，70名患者没有。观察的起点定义为诊断性肾活检的时间，终点定义为需要第一次透析的时间。截至2001年，平均观察时间192.9±74.8个月（48 ~ 326个月）。采用Kaplan-Meier分析和Cox比例风险回归模型评估肾脏生存和协变量的影响。年龄、性别、尿蛋白排泄量、血清肌酐、血清IgA、血压、肾活检时的组织病理学表现及观察期间的治疗情况在行扁桃体切除术和未行扁桃体切除术患者之间无显著差异。切除扁桃体的患者中有5人（10.4%）最终需要透析治疗，未切除扁桃体的患者中有18人（25.7%）最终需要透析治疗（χ 2检验，P = 0.0393）。Kaplan-Meier分析显示，切除扁桃体与未切除扁桃体患者240个月时肾脏存活率分别为89.6%和63.7%，差异有统计学意义（log-rank检验，P = 0.0329）。在多变量Cox回归模型中，扁桃体切除术（风险比为0.22；95% CI为0.06 ~ 0.76;P = 0.0164）对肾脏预后有显著影响。这些结果表明扁桃体切除术对IgAN患者的长期肾脏生存有良好的影响。
Background. Little information has been available until now about the clinical efficacy of tonsillectomy on long-term renal survival of patients with idiopathic immunoglobulin A nephropathy (IgAN).Methods. To investigate the effect of tonsillectomy on long-term renal survival, we reviewed the clinical course of 118 patients with idiopathic biopsy-diagnosed IgAN from 1973 to 1980. Of those, 48 patients received tonsillectomy and 70 patients did not. The starting point of observation was defined as the time of the diagnostic renal biopsy, and the end point as when requiring the first dialysis. Up to 2001, the mean observation time was 192.9 +/- 74.8 months (48-326 months). Renal survival and impact of covariates were evaluated by Kaplan-Meier analysis and Cox proportional hazards regression model.Results. Age, gender, amount of urinary protein excretion, serum creatinine, serum IgA, blood pressure, and histopathologic findings at the time of renal biopsy and treatments during the observation period were not significantly different between patients with and without tonsillectomy. Five (10.4%) of the patients with tonsillectomy and 18 (25.7%) of the patients without tonsillectomy finally required dialysis therapy (chi-square test, P = 0.0393). By Kaplan-Meier analysis, renal survival rates were 89.6% and 63.7% at 240 months in the patients with and without tonsillectomy, respectively, and were significantly different (log-rank test, P = 0.0329). In the multivariate Cox regression model, tonsillectomy (hazard ratio, 0.22; 95% CI, 0.06 to 0.76; P = 0.0164) had a significant effect on renal outcome.Conclusion. These results indicate that tonsillectomy has a favorable effect on long-term renal survival in patients with IgAN.