Ohya Masaki, Otani Haruhisa, Minami Yoshinobu, Yamanaka Shintaro, Mima Toru, Negi Shigeo, Yukawa Susumu, Shigematsu Takashi
Department of Internal Medicine, Wakayam Medical University, Wakayama City, Japan.
Clin Nephrol. 2013 Jul;80(1):47-52. doi: 10.5414/CN107861.
Both steroid pulse (SP) monotherapy and the combination of tonsillectomy and SP therapy (TSP) are effective for achieving clinical remission (CR), defined as negative hematuria and proteinuria, in patients with IgA nephropathy (IgAN). The role of tonsillectomy in the treatment of IgAN has been analyzed only from the aspect of CR or renal survival after TSP treatment, so there is no evidence of its effect on the relapse after CR.
We retrospectively investigated relapse (re-appearance of urinary abnormalities) from CR after TSP or SP monotherapy in 62 IgAN patients (mean follow-up, 70.1 ± 35.3 months). The SP therapy comprised 0.5 g methylprednisolone administered intravenously on 3 consecutive days followed by oral prednisolone (30 mg/day) on 4 consecutive days, with the course repeated 3 times. Oral prednisolone (30 mg/day) was then given on alternative days and gradually tapered and finished over 1 year. Tonsillectomy was performed either before or within 6 months of starting SP therapy.
At baseline, the mean age was 34.6 years, the mean serum creatinine (Cr) level was 0.9 mg/dl, and the mean level of proteinuria was 876 mg/day. There were no differences between the TSP group (41 patients) and SP monotherapy group (21 patients). In total, 24 of the TSP and 10 of the SP patients achieved CR. Of the 34 patients who achieved CR, 13 relapsed after TSP or SP monotherapy. Using Kaplan-Meier analysis, tonsillectomy was associated with a lower incidence of relapse from CR after treatment (p = 0.045). Multivariate Cox regression analysis revealed that tonsillectomy reduced the rate of from CR after SP therapy.
Tonsillectomy was associated with a reduction in the relapse rate from CR after SP therapy in IgAN patients.
对于IgA肾病（IgAN）患者，类固醇脉冲（SP）单一疗法以及扁桃体切除术联合SP疗法（TSP）在实现临床缓解（CR，定义为血尿和蛋白尿转阴）方面均有效。扁桃体切除术在IgAN治疗中的作用仅从TSP治疗后的CR或肾脏存活方面进行了分析，因此尚无证据表明其对CR后复发的影响。
我们回顾性研究了62例IgAN患者（平均随访70.1±35.3个月）在TSP或SP单一疗法后从CR状态复发（尿液异常再次出现）的情况。SP疗法包括连续3天静脉注射0.5g甲泼尼龙，随后连续4天口服泼尼松龙（30mg/天），该疗程重复3次。然后隔天给予口服泼尼松龙（30mg/天），并逐渐减量，在1年内结束。扁桃体切除术在开始SP治疗前或6个月内进行。
基线时，平均年龄为34.6岁，平均血清肌酐（Cr）水平为0.9mg/dl，平均蛋白尿水平为876mg/天。TSP组（41例患者）和SP单一疗法组（21例患者）之间无差异。总共有24例TSP患者和10例SP患者实现了CR。在实现CR的34例患者中，13例在TSP或SP单一疗法后复发。使用Kaplan-Meier分析，扁桃体切除术与治疗后CR复发率较低相关（p = 0.045）。多变量Cox回归分析显示，扁桃体切除术降低了SP治疗后CR的复发率。
扁桃体切除术与IgAN患者SP治疗后CR复发率降低相关。
