摘要
目的观察I外肾病（IgAN）患者血清白蛋白水平对肾脏预后的影响，探讨经免疫抑制治疗获得缓解的IgAN患者长期预后及其相关危险因素。方法收集来自上海仁济医院肾脏内科IgAN患者随访登记资料，分析2005年至2010年期间经肾穿刺活组织检查确诊的IgAN，且经治疗获完全缓解或部分缓解的患者632例。随访时间3年，观察患者肾脏生存情况。结果632例IgAN患者中369例治疗后获得缓解的患者入选本研究，终点事件定义为eGFR下降值≥5ml·min^-1·（1．73m^2）^-1·年^-1，或Scr较基线值翻倍，或进入终末期肾脏病（ESRD）。中位随访时间为49．0（38．0～65．8）个月，至随访终点有61例患者肾脏病进展。多因素Cox回归分析结果表明，随访平均血清肌酐（TA．Scr）、随访平均血清白蛋白（TA．Alb）和随访1年eGFR变化率是影响治疗后缓解IgAN患者长期预后的独立危险因素。TA—Alb是影响肾脏病进展的重要危险因素，TA—Alb每降低1s／L，肾脏病进展危险度升高17％。结论TA—Scr、TA．Alb和随访1年eGFR变化率与治疗后缓解的IgAN患者长期预后独立相关。监测患者平均Alb水平对预测。肾脏预后具有重要价值。
Objective To clarify the long- term renal prognosis and related risk factors of progression for IgA nephropathy （IgAN） patients who achieved remission under current therapy. To identify the target value of the serum albumin level for Chinese patients with IgAN. Methods The patients with biopsyproven primary IgAN in Nephrology Department of Renji Hospital in Shanghai were studied. The survival of renal and the relationships between clinical parameters and renal outcome were assessed. Results A total of 369 patients between Jan 2005 and Dec 2010 were included with a median follow-up time of 49.0 （38.0-65.8） months. All the subjects had achieved a complete remission （CR） or partial remission （PR） following six months＇ therapy after diagnosis. Progressive renal disease had occurred in 61 cases at the end of follow- up. Three variables had a significant independent effect on renal outcome in patients achieving remission under current therapy regimen for IgAN, including time-average serum creatinine （TA-Scr） [HR（95%CI）： 1.03（1.01-1.04）],time-average serum albumin （TA-Alb） [HR（95%CI）： 0.83 （0.69-0.99）], and eGFR ratio within one year [HR（95%CI）： 0.00（0.00-0.01）]. By multivariate Cox analyses, each 1 g/L drop of TA-Alb was related with 17.2% increase in the risk of renal progression. The ROC curve indicated that combination of serum albumin at baseline and during a long-term had a more significant value in prediction of renal outcome than independent predictor alone. By Kaplan-Meier analyses, patients with TA-Alb 〈 38 g/L had a 10.4 fold sinereased risk of progressive disease compared with that of TA- Alb 〉 38 g/L. Conclusions IgAN patients with lower eGFR ratio, higher TA-Scr and lower TA-Alb would progress to ESRD more quickly, and serum albumin during follow- up is important for predicting IgAN progression.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2015年第2期102-108,共7页
Chinese Journal of Nephrology
基金
基金项目：“973”计划（2012CB517602）
港澳台科技合作专项项目（2014DFT30090）
国家自然科学基金（81102700,81373865）
上海市高级中西医结合人才培养项目（ZYSNXD012-RC-ZXY017）
上海市科委项目（12401906400,13401906100）
