摘要
目的分析伴贫血的IgA肾病(IgAN)患者临床病理特征及预后的影响因素。方法回顾性分析于2006年1月1日至2016年12月31日在福建医科大学附属第一医院确诊为原发性IgAN患者的临床和病理资料。按照患者是否贫血分为贫血组和非贫血组,收集比较两组患者的临床和病理资料。以肾活检日期为起点,随访至2018年1月1日,采用Kaplan-Meier法绘制生存曲线,两组生存曲线的比较采用Log-rank检验;采用多因素Cox比例风险模型分析IgAN患者预后的影响因素。结果共纳入231例研究对象,男性122例(52.8%),男∶女=1.12∶1;年龄(34.8±10.1)岁(15~68岁);其中贫血组70例(30.3%),非贫血组161例(69.7%)。与非贫血组比较,贫血组女性患者比例更高,血白蛋白更低,内皮细胞增殖(E1)、肾小管萎缩/肾间质纤维化(T1/2)、新月体形成比例(C1/2)更高,差异均有统计学意义(均P<0.05)。中位随访时间为6.3年(0.3~12.9年)。两组患者生存曲线比较,贫血组患者肾脏累积生存率低于非贫血组(χ^2=15.234,P<0.001)。多因素Cox比例风险模型分析显示,合并高血压(HR=2.988,95%CI1.276~6.999,P=0.012)、24h尿蛋白量升高(HR=1.103,95%CI1.046~1.163,P<0.001)、贫血(HR=3.820,95%CI1.674~8.719,P=0.001)、估算肾小球滤过率(eGFR)<60ml·min^-1·(1.73m2^)^-1(HR=3.725,95%CI1.639~8.462,P=0.002)、肾小管萎缩/间质纤维化(T1/2)(HR=3.770,95%CI1.026~13.852,P=0.046)、肾小球节段硬化/粘连(S1)(HR=4.211,95%CI1.139~15.576,P=0.031)是IgAN患者发生不良肾脏预后的独立危险因素。结论伴贫血的IgAN患者临床病理表现相对较严重,肾脏累积生存率较低。贫血、肾小管萎缩/间质纤维化(T1/2)、肾小球节段硬化/粘连(S1)、高血压、24h尿蛋白量升高、eGFR<60ml?min-1?(1.73m2)-1是IgAN患者发生不良肾脏预后的独立危险因素。
Objective To analyze the clinicopathological features of IgA nephropathy (IgAN) patients with anemia and the influencing factors of prognosis. Methods The clinical and pathological data of patients diagnosed with primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1, 2006 to December 31, 2016 were retrospectively analyzed. The patients were divided into anemia group and non-anemia group according to whether the patient was anemia or not. The clinical and pathological data of the two groups were collected. All of them were followed up from the date of renal biopsy to January 1, 2018. Survival curves of the two groups were drawn by Kaplan-Meier method, and compared by Log-rank test. Multivariate Cox proportional hazards regression model was adopted to explore the influencing factors of prognosis in IgAN patients. Results A total of 231 subjects were enrolled, including 122 males (52.8%), and the male-female ratio was 1.12∶1. Their age was (34.8±10.1) years (15-68 years). There were 70 patients (30.3%) in anemia group, 161 cases (69.7%) in non-anemic group. Compared with non-anemia group, anemia group had higher proportion of females, lower serum albumin, higher proportion of tubular atrophy/interstitial fibrosis (T1/2), endothelial cell proliferation (E1) and crescent formation (C1/2), which were statistically significant (all P<0.05). The patients had a median follow-up time as 6.3 years (0.3-12.9 years). Survival analysis showed that patients in anemia group had lower cumulative renal survival rate than that in non-anemia group (χ^2=15.234, P<0.001). Multivariate Cox hazards regression analysis revealed that anemia (HR=3.820, 95%CI 1.674-8.719, P=0.001), tubular atrophy/interstitial fibrosis (T1/2)(HR=3.770, 95%CI 1.026-13.852, P=0.046), glomerular segmental sclerosis/adhesion (S1)(HR=4.211, 95%CI 1.139-15.576, P=0.031), hypertension (HR=2.988, 95%CI 1.276-6.999, P=0.012), increased 24 h urinary protein (HR=1.103, 95%CI 1.046-1.163, P<0.001) and estimated glomerular filtration (eGFR)<60 ml?min-1?(1.73 m2)-1 (HR=3.725, 95%CI 1.639-8.462, P=0.002) were the independent risk factors for poor renal prognosis in patients with IgAN. Conclusions The clinicopathological features of IgAN patients with anemia are relatively serious, and the renal cumulative survival rate is lower. Anemia, tubular atrophy/interstitial fibrosis (T1/2), glomerular segmental sclerosis/adhesion (S1), hypertension, increased urinary protein and eGFR<60 ml·min^-1·(1.73 m^2)^-1 are the independent risk factors for poor renal prognosis in patients with IgAN.
作者
吴勐
张小红
林矜
万建新
Wu Meng;Zhang Xiaohong;Lin Jin;Wan Jianxin(Department of Nephrology,Longyan First Hospital,Fujian Medical University,Longyan City of Fujian Province 364000,China;Department of Nephrology,the First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2019年第10期752-757,共6页
Chinese Journal of Nephrology
关键词
肾小球肾炎
IgA
贫血
病理学
临床
预后
Glomerulonephritis, IgA
Anemia
Pathology,clinical
Prognosis
