| 芮元帆,唐琳.免疫抑制治疗 IgA肾病 97例的效果及预后分析[J].安徽医药,2021,25(7):1302-1307. |
| 免疫抑制治疗 IgA肾病 97例的效果及预后分析 |
| Effect and prognosis of immunosuppressive therapy of IgA nephropathy:a report of 97cases |
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| DOI：10.3969/j.issn.1009-6469.2021.07.006 |
| 中文关键词: 肾小球肾炎， IGA 免疫抑制剂 肾小球滤过率 蛋白尿 病理 预后 牛津分型 |
| 英文关键词: Glomerulonephritis, IGA Immunosuppressive agents Glomerular filtration rate Proteinuria Pathological Prognosis Oxford classification |
| 基金项目:国家自然科学基金( U1904134) |
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| 中文摘要: |
| 目的分析影响 IgA(免疫球蛋白 A)肾病免疫抑制治疗效果及预后的相关因素。方法回顾性分析 2014年 6月至 2019年 6月在郑州大学第一附属医院肾活检确诊为 lgA肾病的，有完整随访资料的病人 97例。随访终点事件为病人进入终末期肾脏病或血肌酐较基线值翻倍，或因肾脏疾病死亡。将病人按治疗结果分组，分为完全缓解组、部分缓解组以及未缓解组，进行组间差异比较，并分析牛津病理特征与临床特征的相关性。采用 logistics回归分析影响免疫抑制治疗效果的影响因素，采用 Cox回归分析临床病理指标对肾脏预后的影响。结果肾活检同时检测发现，与完全缓解和部分缓解组相比，未缓解组三酰甘油［2.0(1.38，2.48)比 1.53(1.26，2.02)和 1.90(1.31，3.36)］、平均动脉压［109.1(96.2，119.6)比 99(89.1，106.0)和 102.3(93.8， 117.5)］和尿蛋白水平［4.43(2.84，6.09)比 2.40(1.54，5.43)和 2.64(1.95，5.29)］明显高于其他两组，估计肾小球滤过率( eGFR)水平［34.15(24.9，62.1)比 79.9(57.7，96.8)和 54.3(31，106.2)］明显低于其他两组( P<0.05)。伴 T2病变的病人平均动脉压［108.6(97.7，119.6)比 104.8(98.6，114.3)和 95(88.7，108)］、三酰甘油［2.03(1.39，2.730)比 1.61(1.31，2.37)和 1.6(1.21，2.16)］明显高于伴 T1和 T0的病人，而 eGFR水平［35.0(22.0，51.7)比 59.5(39.2，78.9)和 87.7(63.6，118.0)］明显低于伴 T1和 T0的病人(P <0.05)。多因素 logistic回归分析结果显示， eGFR(OR=0.154)、尿蛋白(OR=4.699)和 S病变( 0R=99.456)是影响免疫抑制治疗效果的独立因素( P<0.05)。多因素 Cox回归分析得出 T2病变( HR= 7.802，95%CI:1.755~34.697，P=0.007)及基线 eGFR(HR=0.211，95%CI:0.077~0.577，P=0.002)是免疫抑制治疗后肾脏结局的独立预测因子。结论经免疫抑制治疗后，基线 eGFR、尿蛋白以及 S病变是影响 IgA病人治疗结果的独立因素，仅 eGFR和 T2病变能独立预测 IgA肾病病人的肾脏预后。 |
| 英文摘要: |
| Objective To analyze the factors influencing the efficacy and prognosis of immunosuppressive treatment of IgA (Immunoglobulin A) nephropathy.Methods Ninety-seven patients with IgA nephropathy diagnosed by renal biopsy in the First AffiliatedHospital of Zhengzhou University from June 2014 to June 2019 were retrospectively analyzed, and all patients had complete follow-up data. The follow-up endpoint event was the patient entering end-stage renal disease or blood creatinine doubled from the baseline value,or death due to kidney disease. Patients were assigned into the complete remission group, the partial remission group, and the non-remission group according to the treatment outcome. The differences between groups were compared. The correlations between pathological features and clinical features were analyzed. The factors influencing the outcomes of immunosuppressive therapy were analyzed bylogistics regression. The Cox regression were used to analyze the impact of clinicopathologic indicators on renal prognosis.Results Imultaneous renal biopsy showed that triglycerides [2.0 (1.38, 2.48) vs. 1.53 (1.26, 2.02) and 1.90 (1.31, 3.36)], mean arterial pressure [109.1 (96.2, 119.6) vs. 99 (89.1, 106.0) and 102.3 (93.8, 117.5)], and proteinuria [4.43 (2.84, 6.09) vs. 2.40 (1.54, 5.43) and 2.64 (1.95, 5.29) ] in non-remission group were higher that those in the complete remission group and partial remission group, and eGFR [34.15 (24.9,62.1) vs. 79.9 (57.7, 96.8) and 54.3 (31, 106.2)] in non-remission group was lower than that in the complete remission group and partial remission group (P<0.05). The mean arterial pressure [108.6 (97.7, 119.6) vs. 104.8 (98.6, 114.3) and 95 (88.7, 108)] and triglycerides [2.03 (1.39, 2.730) vs. 1.61(1.31, 2.37) and 1.6(1.21, 2.16)] of patients with T2 lesion were higher that those of patient with T1and T0 lesion, eGFR [35.0 (22.0, 51.7) vs. 59.5 (39.2, 78.9) and 87.7 (63.6, 118.0)] of patients with T2 lesion were lower that those of patient with T1 and T0 lesion (P<0.05). Multivariate logistic regression analysis showed that initial eGFR (OR=0.154),proteinuria (OR= 4.699) and S lesionsl (OR=99.456) were independent factors affecting the effect of immunosuppressive therapy (P<0.05). Multiple Cox regression analysis further confirmed that T2 lesions (HR=7.802, 95%CI: 1.755~34.697, P=0.007) and the initial level of eGFR (HR= 0.211, 95%CI: 0.077~0.577, P=0.002) were independent predictive factors for poor renal outcome.Conclusions After immunosuppressive therapy, initial eGFR, proteinuria and S lesions are independent factors affecting the outcome of IgA patients. Only initial eG?FR and T2 lesion can independently predict renal prognosis of patients with IgA nephropathy. |
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