Watanabe Hirofumi, Goto Shin, Kondo Daisuke, Takata Takuma, Yamazaki Hajime, Hosojima Michihiro, Yamamoto Suguru, Kaneko Yoshikatsu, Aoyagi Ryuji, Narita Ichiei
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoku, Niigata, Niigata, 951-8510, Japan.
Department of Nephrology and Rheumatology, Niigata City General Hospital, Niigata, Japan.
Clin Exp Nephrol. 2017 Apr;21(2):257-265. doi: 10.1007/s10157-016-1282-8. Epub 2016 May 23.
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.
IgA 肾病（IgAN）是一种慢性肾小球疾病，20% - 40%的患者会在 20 年内发展为终末期肾病。已有报道称扁桃体切除术联合类固醇脉冲（SP）给药（TSP）对 IgAN 的临床缓解有效。特别是在日本，TSP 已被广泛应用。然而，TSP 中类固醇给药的最佳方法尚未确立。
我们回顾性比较了接受扁桃体切除术并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 治疗及隔日口服泼尼松龙（3A 组；n = 25）；（2）一个疗程的 SP 治疗及连续口服泼尼松龙（1C 组；n = 22）。
在开始治疗后的 12 个月（48.0%对 40.9%，P = 0.77）、24 个月（68.0%对 72.7%，P = 0.76）以及最终观察时（76.0%对 81.8%，P = 0.73），两组的临床缓解率均无显著差异。3A 组从开始治疗至血尿缓解的平均时间显著短于 1C 组（5.7 ± 4.4 对 9.9 ± 5.9 个月，P = 0.03）。在 24 个月时，3A 组中首次在 SP 治疗后接受他汀类药物治疗的血脂异常患者更多（P = 0.02）。
在 IgAN 患者中，3A 组治疗可能对诱导血尿快速缓解有效。需要进一步研究以建立合适的 TSP 方案。
