摘要
目的扁桃体切除术治疗IgA肾病(IgAN)的疗效目前仍存在争议,这项meta分析旨在评价其作为辅助或独立治疗的疗效,为其在临床中的应用提供更充分的循证学依据。方法计算机检索建库至2022年11月1日在Pubmed、Embase、ScienceDirect、Cochrane library、Web of Science、中国知网(CNKI)、维普网(VIP)、中国生物医学文献数据库(CBM)和万方数据库公开发表的关于扁桃体切除术治疗IgAN的文献,以蛋白尿、血尿、完全缓解率及终末期肾病(ESRD)发生率作为观察点,使用Stata 12.0软件进行统计学分析。结果共纳入36篇文献,涉及5797名原发性IgAN患者。Meta分析结果显示,扁桃体切除术作为辅助或独立治疗手段与单纯药物治疗相比,蛋白尿缓解率显著增加(OR=4.44,95%CI:3.14~6.27),血尿缓解率显著增加(OR=5.11,95%CI:2.92~8.93),完全缓解率显著增加(OR=3.32,95%CI:2.79~3.96),而ESRD发生率显著降低(OR=0.24,95%CI:0.17~0.33)。结论扁桃体切除术作为辅助或独立治疗手段,有助于诱导临床缓解并抑制终末期肾病的进展,临床上应更加重视其应用价值。
Objective The efficacy of tonsillectomy in immunoglobulin A nephropathy(IgAN)still remains controversial.This meta-analysis aims to evaluate the efficacy of tonsillectomy as an auxiliary or independent therapy and provide more evidence-based evidence for its clinical application.Methods We retrieved the literatures about the efficacy of tonsillectomy in IgAN published in Pubmed,Embase,ScienceDirect,Cochrane library,Web of science,Chinese National Knowledge Infrastructure(CNKI),VIP,China Biomedical Literature Database(CBM)and Wanfang databases from the time of establishment to November 1,2022.The rate of proteinuria remission,hematuria remission,complete remission(CR)and end-stage renal disease(ESRD)were taken as observation points and meta-analyse were conducted by using Stata 12.0 software.Results A total of 36 studies representing 5797 patients with primary IgAN were ultimately enrolled.Meta-analysis showed that compared with drug therapy alone,tonsillectomy,as auxiliary or independent therapy,significantly improved proteinuria remission rate(OR=4.44,95%CI:3.14-6.27),hematuria remission rate(OR=5.11,95%CI:2.92-8.93)and CR rate(OR=3.32,95%CI:2.79-3.96),and significantly reduced incidence of ESRD(OR=0.24,95%CI:0.17-0.33).Conclusion As auxiliary or independent treatment,tonsillectomy may induce clinical remission and inhibit the progression of ESRD in patients with IgAN and more attention should be paid to its application value in clinic.
作者
孙帅刚
翟亚玲
张文惠
田慧娟
Sun Shuaigang;Zhai Yaling;Zhang Wenhui;Tian Huijuan(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,the Renal Research Institution of Zhengzhou University,Zhengzhou 450052,China)
出处
《临床荟萃》
CAS
2024年第3期197-207,共11页
Clinical Focus
基金
国家自然科学青年基金项目IgA免疫复合物通过诱导内皮细胞sFlt-1的表达参与IgA肾病血管内皮损伤的机制研究(81600555)
河南省自然科学基金面上项目HMGB2通过增强HMGA1促转录作用参与IgA肾病糖基化异常IgA1产生的机制研究(232300420034)
中国博士后科学基金面上项目IgA免疫复合物参与IgA肾病血管损伤的机制探讨(2018M640684)。
作者简介
通信作者:翟亚玲,Email:zhaiyaling1988@163.com。
