【摘要】 目的探讨IgA肾病患者肾脏生存及其预后影响因素。方法分析北医三院肾内科肾活检确诊且随访时间在1年以上的IgA肾病患者的临床资料及病理改变,以患者进入终末期肾脏病(ESRD)为随访终点,进行Ka-plan-Meier生存分析和多因素Cox回归分析。结果入选的206例IgA肾病患者的平均随访时间为(60.8±44.7)个月,有28例(13.6%)进入EDRD,患者1、5、10和15年的肾存活率分别为95.8%、85.1%、69.7%和50.9%。单因素生存分析发现肾活检时高血压(P<0.001)、血肌酐>132.6μmol/L(P<0.001)、尿蛋白>1.5g/d(P<0.001)、低白蛋白血症(P<0.01)、Lee氏病理分级(P<0.001)、节段性肾小球硬化(P<0.001)、小动脉病变(P<0.001)是患者肾脏存活的影响因素;Cox回归分析发现肾活检时血肌酐(RR=1.02,95%CI1.01～1.03)、尿蛋白(RR=1.16,95%CI1.02～1.33)和Lee氏病理分级(RR=2.91,95%CI1.78～4.77)是IgA肾病患者预后的独立危险因素。结论 IgA肾病患15年后约半数可能进入ESRD,尿蛋白、血肌酐及Lee氏病理分级是其预后的独立危险因素。更多还原

【Abstract】 Objective To investigate the renal survival of IgA nephropathy and analysis the relative risk factors. Methods Clinical and pathologic data of IgA nephropathy confirmed by renal biopsy and followed for at least 1 year were reviewed retrospectively in Peking University Third Hospital. Study endpoint was defined as end stage renal disease (ESRD). Kaplan-Meier survival analysis and Cox regression models were used to analyze renal survival and risk factors of progression respectively. Results 206 eligible cases were analyzed with a median follow-up of (60.8±44.7) months.During the follow-up period,28(13.6%) cases of them reached the endpoint. The cumulative renal survival rate was 95.8% at 1 year,85.1% at 5 years,69.7% at 10 years and 50.9% at 15years. Uni-variate analysis showed that the following parameters at the time of biopsy were significantly correlated with poor renal survival:hypertension (P < 0.001),serum creatinine>132.6μmol/L(P < 0.001),proteinuria>1.5g/d(P < 0.001),hypoalbuminaemia (P < 0.01),Lee’s glomerular grading score (P < 0.001),vascular lesions (P < 0.001) andsegmental glomerulosclerosis in pathology(P < 0.001). The Cox regression analysis revealed that only serum creatinine level (RR=1.02,95%CI 1.01~1.03),urine protein excretion (RR=1.16,95%CI 1.02~1.33) and Lee’s glomerular grading score (RR=2.91,95%CI 1.78~4.77) were independent prognostic indicators. Conclusions Approximately half of the patients with IgA nephropathy may progress into ESRD after fifteen years. Urine protein excretion,serum creatinine and Lee’s glomerular grading system are independent predictors of renal survival of IgA nephropathy.更多还原