Beneficial effects of tonsillectomy plus steroid pulse therapy on inflammatory and tubular markers in patients with IgA nephropathy.
Beneficial effects of tonsillectomy plus steroid pulse therapy on inflammatory and tubular markers in patients with IgA nephropathy.
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DOI：
10.1016/j.krcp.2016.09.002
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发表时间：
2016-12
影响因子：
3
通讯作者：
Tomino, Yasuhiko
中科院分区：
文献类型：
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作者：
Maruyama, Shuntaro;Gohda, Tomohito;Suzuki, Yusuke;Suzuki, Hitoshi;Sonoda, Yuji;Ichikawa, Saki;Li, Zi;Murakoshi, Maki;Horikoshi, Satoshi;Tomino, Yasuhiko
伊加肾病（IgAN）是世界范围内最常见的原发性肾小球肾炎。扁桃体切除术加类固醇脉冲治疗已能够诱导早期IgAN的临床缓解。然而，其对全身和局部细胞因子和肾小管标志物的可能影响尚未得到充分研究。我们从38名患者中采集了肾活检和第三次类固醇冲击治疗前的血清和尿液样本。采用免疫测定法检测肾小管损伤标志物（如N-乙酰-β-d-氨基葡萄糖苷酶）和肾损伤分子-1以及炎症标志物（如白细胞介素（IL）-6、单核细胞趋化蛋白（MCP）-1、细胞间粘附分子（ICAM）-1和血管细胞粘附分子（VCAM）-1）。在肾活检之前，除了MCP-1之外，只有尿液炎症标记物与肾小球（蛋白尿）和/或肾小管损伤标记物相关。治疗后蛋白尿、血尿和估计肾小球滤过率显著改善。此外，血清IL-6和ICAM-1水平和所有尿液标志物均显著下降;然而，血清MCP-1和VCAM-1水平没有下降。尿中炎症标志物与血清炎症标志物无相关性。扁桃体切除加激素冲击治疗IgAN不仅可以改善肾小球损伤指标，还可以通过改善局部肾脏炎症来改善肾小管损伤指标。
IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. Tonsillectomy plus steroid pulse therapy has been able to induce clinical remission in early-stage IgAN. However, its possible effect on systemic and local cytokines and tubular markers has not been fully investigated. We obtained serum and urine samples from 38 patients just before renal biopsy and third steroid pulse therapy. Markers of tubular damage such as N-acetyl-β-d-glucosaminidase, and kidney injury molecule-1 and inflammation such as interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, intercellular adhesion molecule (ICAM)-1, and vascular cell adhesion molecule (VCAM)-1 were measured by immunoassay. Before renal biopsy, only urinary inflammatory markers, except MCP-1, were associated with glomerular (proteinuria) and/or tubular damage markers. Proteinuria, hematuria, and estimated glomerular filtration rate dramatically improved after therapy. In addition, levels of serum IL-6 and ICAM-1 and all urinary markers declined significantly; however, serum MCP-1 and VCAM-1 levels did not. None of the urinary markers correlated with the serum inflammatory markers. Tonsillectomy plus steroid pulse therapy for patients with IgAN might be useful for improving not only glomerular damage marker but also tubular damage markers through the improvement of local renal inflammation.