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新月体类型及比例在过敏性紫癜性肾炎预后分析中的作用 被引量:10

The predictive value of crescents in adult Henoch-Scholein purpura nephritis
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摘要 目的研究过敏性紫癜性肾炎患者肾组织中新月体类型与比例在肾脏预后分析中的作用。方法回顾性分析2005年1月至2015年12月在浙江大学医学院附属第一医院确诊的275例过敏性紫癜性肾炎患者临床病理资料,根据肾组织病理检查结果分为4组:无新月体(NC)组(99例);仅有节段性新月体(SC)组(35例);有大新月体且大新月体比例<25%(C1)组(122例);有大新月体且大新月体比例≥25%(C2)组(19例)。肾脏预后不良终点事件定义为随访2年内估算肾小球滤过率(eGFR)较基线值下降30%以上,或随访期内血肌酐较基线值翻倍,或进入终末期肾病。用Kaplan-Meier生存曲线分析比较各组患者肾脏存活率的差异;多因素Cox回归模型分析肾脏预后不良的独立危险因素。结果各组患者年龄、肾外器官表现、平均动脉压等项目的差异无统计学意义。各组间血清肌酐水平(P=0.001)、eGFR(P=0.003)、尿蛋白量(P<0.001)的差异有统计学意义。各组患者球性硬化比例、系膜增生程度、间质炎症/纤维化等项目的差异无统计学意义。中位随访时间86(58,116)个月,NC组、SC组、C1组、C2组患者肾脏存活率分别为96.0%、100.0%、83.6%和68.4%。Kaplan-Meier生存分析结果显示各组患者肾脏存活率的差异有统计学意义(Log-Rank=23.24,P<0.001)。多因素Cox回归分析结果显示,有大新月体(HR=3.59,95%CI 1.34~9.62,P=0.008)和基线eGFR水平低[每增加1 ml?min-1?(1.73 m2)-1,HR=0.979,95%CI 0.968~0.989,P<0.001]是过敏性紫癜性肾炎肾脏预后不良的独立危险因素。结论有大新月体和基线eGFR低是过敏性紫癜性肾炎患者肾脏不良预后的独立危险因素。 Objective To study the renal prognosis with the type and proportion of crescentic in adult Henoch Schonlein purpura nephritis (HSPN). Methods A total of 275 HSPN cases diagnosed in the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. According to the pathological results, they were divided into four groups: 99 patients in none crescent group (NC), 35 patients in segmental crescents group (SC), 122 patients with circumferential crescent <25%(C1), and 19 patients with circumferential crescent≥25%(C2). Renal prognostic events were defined as estimated glomerular filtration rate (eGFR) decreased by 30% over baseline within 2 years, doubling of serum creatinine or end-stage renal disease during follow-up. Kaplan-Meier survival analysis was used to compare the renal survival rate of each group. Univariate and multivariate Cox regression model was used to recognize the risk factor of poor renal outcome. Results There was no significant difference in age, extra renal organ performance and mean arterial pressure among groups. Among NC group, SC group, C1 group and C2 group, difference in serum creatinine (P=0.001), eGFR (P=0.003) and proteinuria levels (P<0.001) were statistically significant. There was no significant difference in the ratio of global sclerosis, mesangial hypercellularity and interstitial inflammation/fibrosis among the groups. The patients were followed up for 86(58, 116) months. The renal survival rates of NC group, SC group, C1 group and C2 group were 96%, 100%, 83.6% and 68.4% respectively. Kaplan-meier survival analysis showed significant differences (Log Rank=23.24, P<0.001). Cox multivariate regression analysis indicated that presence of circumferential crescent (HR=3.59, 95%CI 1.34-9.62, P=0.008) and low eGFR (HR=0.979, 95%CI 0.968-0.989, P<0.001) were independent prognostic factors. Conclusion The presence of circumferential crescent and low eGFR level are independent risk factors for poor renal prognosis in HSPN patients.
作者 马黎丽 黄晓涵 任萍萍 陈亮亮 王红亚 韩海冬青 陈江华 韩飞 Ma Lili;Huang Xiaohan;Ren Pingping;Chen Liangliang;Wang Hongya;Han Haidongqin;Chen Jianghua;Han Fei(Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Institute of Nephrology, Zhejiang University, Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province. Hangzhou 310003, China)
出处 《中华肾脏病杂志》 CAS CSCD 北大核心 2019年第5期367-372,共6页 Chinese Journal of Nephrology
基金 国家自然科学基金面上项目(81570605、81770674) 浙江省自然科学基金面上项目(LY15H050004).
关键词 紫癜 过敏性 肾炎 预后 新月体 Henoch-Scholein purpura Nephritis Prognosis Crescent
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