Kondo Norio, Moriyama Takahito, Tachikawa Mayako, Tomita Erika, Hattori Ai, Yamamura Yukie, Nonaka Manabu
Department of Otolaryngology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Auris Nasus Larynx. 2019 Oct;46(5):764-771. doi: 10.1016/j.anl.2019.01.003. Epub 2019 Jan 18.
We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.
We analyzed 118 IgAN patients who underwent TSP. We collected patients' data retrospectively, including age, sex, blood pressure, onset of IgAN, pathological findings of a renal biopsy, serum concentration of creatinine, estimated glomerular filtration rate, serum concentration of protein, urinary protein, hematuria, past history of tonsillitis, the Yamamoto scale, the weight and pathological findings of the extracted palatine tonsils, and the presence or absence of anti-platelet drugs and renin-angiotensin system inhibitors (RAS-I) usage. This study included participants who were over 18 years of age, had undergone tonsillectomy within three months of steroid pulse therapy administered thrice, in whom renal biopsy was performed within a year before treatment, and with follow-up period of over 3 years. Clinical remission (CR) of urinary abnormalities was defined as remission of both proteinuria and hematuria: three consecutive negative results over a 6-month period, with a urinary sediment red blood cell count of <5/HPF, and a proteinuria qualitative reaction of (-) to (±).
The CR rate of all cases was 56.8% and statistical significance was observed with respect to the C-Grade (P = 0.0003, P = 0.028) using both univariate and multivariate analysis. The CR rate of C-Grade І (73.4%) patients was significantly higher than that of C-Grade II patients (39.0%; P = 0.0004) and C-Grade III patients (30.8%; P = 0.003). We analyzed clinical factors in each C-Grade patient. No statistical significance was observed with respect to any of the factors using univariate analysis in C-Grade I patients. The weight of the extracted palatine tonsils and Yamamoto scale showed no statistical significance in every analysis. Fibrosis or hyalinization of the stroma of the palatine tonsils showed statistical significance (P = 0.026) only in the univariate analysis of C-Grade III patients. However, the patient number of C-Grade III was small.
Our results indicate that TSP is mostly effective in patients with of C-Grade I IgAN and that the C-Grade reflects the clinical indication for TSP. The weight of the extracted palatine tonsils and Yamamoto scale did not show obvious correlations with the clinical effect of TSP.
我们研究了接受扁桃体切除术加类固醇脉冲疗法（TSP）治疗免疫球蛋白A肾病（IgAN）的患者，以调查与该治疗阳性反应相关的临床因素。
我们分析了118例接受TSP治疗的IgAN患者。我们回顾性收集了患者的数据，包括年龄、性别、血压、IgAN发病情况、肾活检的病理结果、血清肌酐浓度、估计肾小球滤过率、血清蛋白浓度、尿蛋白、血尿、扁桃体炎既往史、山本评分、切除的腭扁桃体的重量和病理结果，以及是否使用抗血小板药物和肾素-血管紧张素系统抑制剂（RAS-I）。本研究纳入了年龄超过18岁、在三次类固醇脉冲治疗的三个月内接受扁桃体切除术、在治疗前一年内进行肾活检且随访期超过3年的参与者。尿异常的临床缓解（CR）定义为蛋白尿和血尿均缓解：在6个月内连续三次阴性结果，尿沉渣红细胞计数<5/HPF，蛋白尿定性反应为（-）至（±）。
所有病例的CR率为56.8%，单因素和多因素分析均显示C级具有统计学意义（P = 0.0003，P = 0.028）。C级Ⅰ患者的CR率（73.4%）显著高于C级Ⅱ患者（39.0%；P = 0.0004）和C级Ⅲ患者（30.8%；P = 0.003）。我们分析了每个C级患者的临床因素。在C级Ⅰ患者的单因素分析中，任何因素均未显示出统计学意义。在每次分析中，切除的腭扁桃体重量和山本评分均未显示出统计学意义。腭扁桃体基质的纤维化或玻璃样变仅在C级Ⅲ患者的单因素分析中显示出统计学意义（P = 0.026）。然而，C级Ⅲ患者的数量较少。
我们的结果表明，TSP对C级Ⅰ IgAN患者最有效，且C级反映了TSP的临床适应证。切除的腭扁桃体重量和山本评分与TSP的临床效果没有明显相关性。
