Nagasawa Yasuyuki, Iio Kenichiro, Fukuda Shinji, Date Yasuhiro, Iwatani Hirotsugu, Yamamoto Ryohei, Horii Arata, Inohara Hidenori, Imai Enyu, Nakanishi Takeshi, Ohno Hiroshi, Rakugi Hiromi, Isaka Yoshitaka
Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan ; Division of Kidney and Dialysis, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-Cho, Nishinomiya, Japan.
Department of Geriatric Medicine and Nephrology, Osaka University, Graduate School of Medicine, Yamada-oka, Suita, Osaka, Japan.
PLoS One. 2014 Jan 28;9(1):e81636. doi: 10.1371/journal.pone.0081636. eCollection 2014.
Immunoglobulin (Ig)A nephropathy (IgAN) is the most common form of primary glomerulonephritis in the world. Some bacteria were reported to be the candidate of the antigen or the pathogenesis of IgAN, but systematic analysis of bacterial flora in tonsil with IgAN has not been reported. Moreover, these bacteria specific to IgAN might be candidate for the indicator which can predict the remission of IgAN treated by the combination of tonsillectomy and steroid pulse.
We made a comprehensive analysis of tonsil flora in 68 IgAN patients and 28 control patients using Denaturing gradient gel electrophoresis methods. We also analyzed the relationship between several bacteria specific to the IgAN and the prognosis of the IgAN. Treponema sp. were identified in 24% IgAN patients, while in 7% control patients (P = 0.062). Haemophilus segnis were detected in 53% IgAN patients, while in 25% control patients (P = 0.012). Campylobacter rectus were identified in 49% IgAN patients, while in 14% control patients (P = 0.002). Multiple Cox proportional-hazards model revealed that Treponema sp. or Campylobactor rectus are significant for the remission of proteinuria (Hazard ratio 2.35, p = 0.019). There was significant difference in remission rates between IgAN patients with Treponema sp. and those without the bacterium (p = 0.046), and in remission rates between IgAN patients with Campylobacter rectus and those without the bacterium (p = 0.037) by Kaplan-Meier analysis. Those bacteria are well known to be related with the periodontal disease. Periodontal bacteria has known to cause immune reaction and many diseases, and also might cause IgA nephropathy.
This insight into IgAN might be useful for diagnosis of the IgAN patients and the decision of treatment of IgAN.
免疫球蛋白A（IgA）肾病（IgAN）是全球最常见的原发性肾小球肾炎类型。有报道称某些细菌可能是IgAN的抗原候选物或发病机制，但尚未见对IgAN患者扁桃体中细菌菌群的系统分析报道。此外，这些IgAN特有的细菌可能是预测扁桃体切除联合类固醇冲击治疗后IgAN缓解情况的指标候选物。
我们采用变性梯度凝胶电泳方法对68例IgAN患者和28例对照患者的扁桃体菌群进行了综合分析。我们还分析了几种IgAN特有的细菌与IgAN预后之间的关系。在24%的IgAN患者中检测到密螺旋体属，而在7%的对照患者中检测到（P = 0.062）。在53%的IgAN患者中检测到迟钝嗜血杆菌，而在25%的对照患者中检测到（P = 0.012）。在49%的IgAN患者中检测到直肠弯曲菌，而在14%的对照患者中检测到（P = 0.002）。多因素Cox比例风险模型显示，密螺旋体属或直肠弯曲菌对蛋白尿缓解具有显著意义（风险比2.35，p = 0.019）。通过Kaplan-Meier分析，携带密螺旋体属的IgAN患者与未携带该菌的患者缓解率存在显著差异（p = 0.046），携带直肠弯曲菌的IgAN患者与未携带该菌的患者缓解率也存在显著差异（p = 0.037）。众所周知，这些细菌与牙周疾病有关。牙周细菌已知会引发免疫反应和多种疾病，也可能导致IgA肾病。
这种对IgAN的认识可能有助于IgAN患者的诊断和治疗决策。
