Comparison of methods of steroid administration combined with tonsillectomy for IgA nephropathy patients
Comparison of methods of steroid administration combined with tonsillectomy for IgA nephropathy patients
复制标题
DOI：
10.1007/s10157-016-1282-8
复制
发表时间：
2017-04-01
影响因子：
2.3
通讯作者：
Narita, Ichiei
中科院分区：
文献类型：
--
作者：
Watanabe, Hirofumi;Goto, Shin;Narita, Ichiei
IgA 肾病 (IgAN) 是一种慢性肾小球疾病，20-40% 的患者会在 20 年内导致终末期肾病。扁桃体切除术联合类固醇脉冲 (SP) 给药 (TSP) 对 IgAN 临床缓解的疗效已有报道。特别是在日本，TSP得到了广泛的应用。然而，TSP 中类固醇给药的最佳方法尚未确定。我们回顾性比较了扁桃体切除术联合两种不同类固醇给药方法治疗的 IgAN 患者的临床缓解情况：（1）三个疗程的 SP 治疗和隔日口服泼尼松龙（3A 组；n = 25）； (2) 一个疗程的 SP 治疗和连续几天口服泼尼松龙 (组 1C；n = 22)。 两组在开始治疗后 12 个月 (48.0 vs. 40.9 %，P = 0.77) 和 24 个月 (68.0 vs. 72.7 %，P = 0.76) 和最终观察时 (76.0) 的临床缓解率无显着差异。对比 81.8%，P = 0.73）。 3A组从开始治疗到血尿缓解的平均时间显着短于1C组（5.7±4.4 vs. 9.9±5.9个月，P = 0.03）。 SP治疗后首次接受他汀类药物治疗的血脂异常患者在24个月时更多出现在3A组中（P = 0.02）。在IgAN患者中，3A组的治疗可能有效诱导血尿快速缓解。需要进一步研究来建立适当的 TSP 协议。
IgA nephropathy (IgAN) is a chronic glomerular disease that causes end-stage renal disease in 20-40 % of patients within 20 years. The efficacy of tonsillectomy combined with steroid pulse (SP) administration (TSP) for clinical remission of IgAN has been reported. Particularly in Japan, TSP has been performed widely. However, the optimum method for steroid administration in TSP has not been established.We retrospectively compared clinical remission in IgAN patients treated with tonsillectomy combined with two different steroid administration methods: (1) three courses of SP therapy and oral prednisolone administered on alternate days (group 3A; n = 25); and (2) one course of SP therapy and oral prednisolone administered on consecutive days (group 1C; n = 22).There was no significant difference in the clinical remission rates between the two groups at 12 (48.0 vs. 40.9 %, P = 0.77) and 24 months after starting treatment (68.0 vs. 72.7 %, P = 0.76) and at the final observation (76.0 vs. 81.8 %, P = 0.73). The mean period from starting treatment to remission of hematuria in group 3A was significantly shorter than that in group 1C (5.7 +/- 4.4 vs. 9.9 +/- 5.9 months, P = 0.03). Dyslipidemic patients treated for the first time with statin after the SP therapy were more present in group 3A at 24 months (P = 0.02).In IgAN patients, treatment of group 3A may be effective for inducing rapid remission of hematuria. Further studies are needed to establish an appropriate protocol for TSP.