摘要
目的探讨伴IgM沉积的IgA肾病患者的临床、病理特征及预后。方法回顾分析2001年至2007年本院肾活检确诊为IgA肾病的患者1060例，并根据肾小球免疫荧光检查是否有IgM沉积分为IgM沉积组和IgM阴性组。随访至患者血肌酐翻倍、肾小球滤过率下降超过50％、进入终末期肾病、肾替代治疗或死亡。采用Kaplan-Meier生存分析评估两组患者肾脏生存率，单因素及多因素COX比例风险回归模型分析IgM沉积对IgA肾病患者预后的影响。结果1060例IgA肾病患者中IgM沉积组750例，IgM阴性组310例。（1）临床指标，IgM沉积组患者24h尿蛋白量、尿酸均高于IgM阴性组（均P〈0．05），其他项目两组差异均无统计学意义（均P〉0．05）；IgM沉积组患者血清IgA、IgG、IgM均高于IgM阴性组（均P〈0．05）。（2）病理指标，IgM沉积组节段性硬化或粘连（牛津分型s1），炎细胞浸润、系膜增生等活动性病变，肾小管萎缩、肾小球节段损伤等慢性病变评分均高于lgM阴性组（均P〈0．05）。（3）中位随访时间89．7（61．8，113．4）个月，Kaplan-Meier生存分析提示IgM沉积的IgA。肾病患者肾脏累计生存率低于IgM阴性组（Log-rank检验X^2=4．95，P=0．026）。单因素COX比例风险回归模型中IgM沉积为IgA肾病患者发生终点事件的危险因素（珊：1．597，95％CI：1．053～2．422，P=0．027）；经多因素COX比例回归模型矫正，IgM沉积对IgA。肾病发生终点事件的影响无统计学意义（HR=I．409，95％CI：0．921～2．156，P=0．114）。结论伴IgM沉积的IgA肾病患者尿蛋白高于IgM阴性患者，病理损伤及免疫荧光沉积程度相对较严重。IgM沉积对IgA肾病肾脏存活存在一定影响，然而IgM沉积并没有成为肾功能进展的独立危险因素。
Objective To determine the correlation of IgM deposition with clinic-pathological features and outcomes of IgA nephropathy patients, Methods A total of 1060 patients, who were diagnosed as IgA nephropathy by renal biopsies between 2001 and 2007 in Guangxing Hospital were enrolled. According to immunofluorescent test, patients were divided into patients with mesangial IgM deposition and patients without IgM deposition. Renal survival curves were assessed by Kaplan-Meier method. The effect of IgM deposition on outcomes of IgA nephropathy patients was examined by univariate and muhivariable Cox proportional- hazards regression. Results Among 1060 IgA nephropathy patients, there were 750 patients with IgM deposition and 310 patients without IgM deposition. （1） Urinary protein and uric acid in patients with IgM deposition were significantly higher than those in patients without IgM deposition （all P 〈 0.05）. Other clinical indicators shown no statistical difference （all P 〉 0.05）. Moreover, IgM deposition patients had higher serum IgA, serum IgG and serum IgM （all P 〈 0.05）. （2） In pathological indicators, IgM deposition patients had more segmented sclerosis or adhesions （SI of Oxford classification）, activity lesions as inflammatory cell infiltration and mesangial proliferation, and chronic pathological changes as tubular atrophy, segmented glomerular damage than patients without IgM deposition （all P 〈 0.05）. （3） All patients were followed- up for a median of 89.7（61.8, 113.4） months, Kaplan- Meier analysis revealed that kidney survival rate was significantly lower in IgM deposition patients compared with patients without IgM deposition （Log-rank X^2=4.95, P-0.026）. In a univariate Cox hazards regression mode, IgM deposition was a risk factor for poor prognosis of IgA nephropathy patients （HR=1.597, 95% CI 1.053- 2.422, P=0.027）. However, in a multivariable Cox analysis, IgM deposition shown no influence on outcomes of IgA nephropathy patients （HR=l.409, 95% CI 0.921 -2.156, P=0.114）. Conclusions IgA nephropathy patients with IgM deposition have higher urinary protein, and more serious pathological damage and immune fluorescence deposition. IgM deposition affects renal survival of IgA nephropathy, while IgM deposition is not an independent risk factor for prognosis of IgA nephropathy.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2017年第1期8-14,共7页
Chinese Journal of Nephrology
基金
浙江省中医药重大疾病科技创新平台科研专项（2009ZDJB02）
浙江省科技厅课题（2012C33032）
