摘要
目的探讨伴有肉眼血尿的IgA肾病患者的临床病理特点及影响预后的危险因素。方法收集2010年1月1日至2019年6月30日于青岛大学附属医院确诊为原发性IgA肾病患者的临床及病理资料,根据其病程中是否伴有肉眼血尿分为肉眼血尿组和非肉眼血尿组,比较两组患者的临床病理特点及预后。以肾活检日为起点,随访至2020年6月30日,应用Kaplan-Meier生存曲线比较两组的肾脏生存率的差异;应用Cox回归模型分析影响肾脏预后的危险因素。结果共纳入490例IgA肾病患者,男∶女=1.33∶1,合并肉眼血尿者111例(22.7%)。肉眼血尿组患者的年龄、高血压发生率、24 h尿蛋白量、血肌酐、血尿酸、血甘油三酯、血总胆固醇水平以及系膜细胞增生(M1)、肾小管萎缩/肾间质纤维化(T1/2)比例均低于非肉眼血尿组(均P<0.05),估算肾小球滤过率(eGFR)高于非肉眼血尿组(P<0.05)。其中随访至少6个月的患者有426例(86.9%),包括93例肉眼血尿患者和333例非肉眼血尿患者,两组患者在治疗方案上差异无统计学意义(均P>0.05)。随访后比较,非肉眼血尿组发生终点事件比例更高[18.6%(62/333)比6.5%(6/93),χ^(2)=8.023,P<0.05],Kaplan-Meier生存分析示肉眼血尿组的肾脏累积生存率高于非肉眼血尿组(χ^(2)=11.44,P<0.01)。多因素Cox回归分析显示尿蛋白>1 g/24 h、eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1)、高血压、高尿酸血症、血清IgA/C3升高是肾脏不良预后的危险因素[HR(95%CI)分别为3.457(1.137~10.514)、2.736(1.073~6.977)、2.720(1.144~6.465)、2.789(1.102~7.060)、1.070(1.009~1.135),均P<0.05]。结论病程中伴有肉眼血尿的IgA肾病患者的肾脏损害较非肉眼血尿患者轻,且肾脏累积存活率高于非肉眼血尿患者,尿蛋白>1.0 g/d、高血压、高尿酸血症及血清IgA/C3升高是不良终点事件的危险因素,应及时给予关注和相应治疗。
Objective To investigate the clinicopathological features and prognosis of IgA nephropathy(IgAN)patients with gross hematuria.Methods The clinical and pathological data of 490 primary IgAN patients admitted in the Affiliated Hospital of Qingdao University from January 2010 to June 2019 were analyzed.Patients were divided into gross hematuria group and non-gross hematuria group.The clinical and pathological features and prognosis were compared between the two groups.All patients were diagnosed by kidney biopsy,and followed up until June 30,2020.Kaplan-Meier survival curve was used to examine the renal survival,and Cox regression model was used to analyze the risk factors affecting renal survival in two groups.Results Among 490 patients there were 111 patients(22.7%)in the gross hematuria group and 379 patients(77.3%)in the non-gross hematuria group.Age,hypertension,24-h urine protein,serum creatinine,blood uric acid,blood triglycerides,total blood cholesterol level,mesangial cell hyperplasia(M1),the proportion of renal tubular atrophy or renal interstitial fibrosis(T1/2)in gross hematuria group were lower than those in non-gross hematuria group(P<0.05),while the estimated glomerular filtration rate(eGFR)in gross hematuria group was higher than those in non-gross hematuria group(P<0.05).Four hundred and twenty six patients(86.9%)were followed up for at least 6 months,including 93 patients in gross hematuria group and 333 patients in non-gross hematuria group.There was no statistically significant difference in treatment method between the two groups(P>0.05).The incidence of end-point events in non-gross hematuria group was higher than that in gross hematuria group[18.6%(62/333)vs.6.5%(6/93),χ^(2)=8.023,P<0.05].Kaplan-Meier survival analysis showed that the cumulative renal survival rate of the gross hematuria group was higher than that of the non gross hematuria group(χ^(2)=11.44,P<0.001).Multivariate Cox regression analysis showed that urine protein>1 g/24 h,eGFR<60 ml·min^(-1)·(1.73 m^(2))^(-1),hypertension,h
作者
谷晓娟
王惠芳
尹文娟
胥雪玲
刘莹莹
郭丹丹
刘雪梅
Gu Xiaojuan;Wang Huifang;Yin Wenjuan;Xu Xueling;Liu Yingying;Guo Dandan;Liu Xuemei(Department of Nephrology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《中华全科医师杂志》
2021年第5期581-586,共6页
Chinese Journal of General Practitioners
基金
青岛市民生科技计划项目(19-6-1-18-nsh)
青岛大学医学部“临床医学+X”工程科研项目(2018-21)。
关键词
肾病
IGA肾病
肉眼血尿
临床特点
预后
Nephrosis
IgA nephropathy
Gross hematuria
Clinical characteristics
Prognosis
