抗肾小球基底膜抗体相关疾病的预后研究  

Prognosis of anti-glomerular basement membrane antibody associated diseases:predictive value of clinical,histological and serological data

作　　者：崔昭[1] 赵明辉[1] 刘玉春[1] 王海燕[1] 

机构地区：[1]北京大学第一医院肾内科暨北京大学肾脏病研究所,100034

出　　处：《临床内科杂志》2004年第10期677-680,共4页Journal of Clinical Internal Medicine

基　　金：中华医学基金专项人才基金 (ORF980 2 )

摘　　要：目的　探讨决定抗肾小球基底膜 (GBM )抗体相关疾病预后的可能因素。方法　对我科近 6年来确诊的 10 5例抗GBM抗体相关疾病患者中 ,有完整临床和病理资料 ,并接受治疗的69例患者进行回顾性分析。对临床完全缓解 ( 5例 )、部分缓解 ( 10例 )和治疗无效 ( 5 4例 )的患者进行比较 ,确定决定预后的因素。结果　决定肾脏预后的因素为 :1.确诊时Scr >60 0 μmol/L者 ,预后较差 (P <0 .0 1) ;2 .出现少尿或无尿者 ,预后较差 (P <0 .0 1) ;3 .肾小球中新月体所占比例 >85 %者 ,预后较差 (P <0 .0 1) ;4.以肺出血为首发表现者 ,预后较好 ,以肾脏受累为首发表现者 ,预后差(P <0 .0 5 ) ;5 .对于确诊时Scr <60 0 μmol/L或以肺脏受累为首发表现的患者 ,给予血浆置换治疗能够改善预后 (P <0 .0 5 )。结论　及时检测血清抗GBM抗体 ,早诊断 ,早治疗 ,是改善病人预后的关键。Objective To identify the prognostic factors of patients with anti-glomerular basement membrane (GBM) antibody associated diseases.Methods The data from 69 patients with anti-GBM diseases diagnosed in our hospital in the last 6 years were retrospectively analyzed.Clinical and pathological data of patients with complete clinical remission (n=5),patients with partial remission (n=10), and patients with treatment failure (n=54) were compared and the prognostic factors were evaluated.Results The following factors predict poor prognosis:(1)serum creatinine > 600(mol/l on diagnosis (P<0.01);(2)oliguria or anuria (P<0.01);(3)a high percentage (>%) of glomeruli had crescents (P<0.01);(4)kidney involvement before lung hemorrhage (P<0.05).Intensive plasma exchange therapy predicts a better prognosis in the patients with serum creatinine less than 600 μmol/l or lung hemorrhage before kidney involvement (P<0.05).Conclusion Early diagnosis by detecting circulating anti-GBM antibodies is crucial to improve prognosis.Sufficient plasmapheresis is the first choice of treatment.

关 键 词：肾疾病 预后 抗肾小球基底膜抗体 

分 类 号：R692[医药卫生—泌尿科学]