Rasche Franz Maximilian, Sailer Leif-Conradin, Czock David, Keller Frieder
Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany.
Acta Otolaryngol Suppl. 2004 Dec(555):32-7. doi: 10.1080/03655230410003305.
In progressive IgA-nephropathy (IgAN) no established therapy exists. We have analyzed the clinical course of 40 patients with progressive IgAN with tonsillectomy combined with cyclophosphamide (TE/CTX), high dose immunoglobulins (IVIG), or cyclophosphamide pulses (CyP), and 8 untreated patients as historical controls. Serum creatinine >250 micromol/l at beginning, proteinuria >2.5 g/l, and age >51 years were significant predictors for end stage renal failure in Cox regression analysis. In linear regression analysis, the decline of renal function significantly decreased only in patients after CyP from 29.7% per year to 2.8% per year. Proteinuria significantly decreased only in patients after CyP from 1.3 g/l to 1.1 g/l. IVIG had no maintained long term effect on renal function, and TE/CTX had no significant influence on renal function. In Kaplan Meier analysis, patients with CyP had a significantly higher cumulative probability of renal survival compared to the other patients. In conclusion, TE/CTX is not recommended in patients with advanced, progressive IgAN, if not surgically indicated. IVIG had no long-term effect on progression of IgAN. CyP therapy is able to stop the loss of renal function and decreases proteinuria in patients with progressive IgAN.
在进行性IgA肾病（IgAN）中，尚无既定的治疗方法。我们分析了40例进行性IgA肾病患者的临床病程，这些患者接受了扁桃体切除术联合环磷酰胺（TE/CTX）、大剂量免疫球蛋白（IVIG）或环磷酰胺冲击治疗（CyP），并将8例未治疗的患者作为历史对照。在Cox回归分析中，开始时血清肌酐>250微摩尔/升、蛋白尿>2.5克/升以及年龄>51岁是终末期肾衰竭的显著预测因素。在线性回归分析中，仅接受CyP治疗的患者肾功能下降显著减缓，从每年29.7%降至每年2.8%。仅接受CyP治疗的患者蛋白尿显著减少，从1.3克/升降至1.1克/升。IVIG对肾功能没有长期维持作用，TE/CTX对肾功能没有显著影响。在Kaplan Meier分析中，与其他患者相比，接受CyP治疗的患者肾脏存活的累积概率显著更高。总之，对于晚期进行性IgA肾病患者，若没有手术指征，不推荐使用TE/CTX。IVIG对IgA肾病的进展没有长期影响。CyP治疗能够阻止进行性IgA肾病患者肾功能丧失并减少蛋白尿。
