成人特发性局灶节段性肾小球硬化的预后分析  

Long-term outcome of adult patients with idiopathic focal segmental glomerulosclerosis

作　　者：汤曦[1] 刘志红[2] 徐峰[2] 曾彩虹[2] 张炯[2] 吴青[2] 张庆燕[2] 黎磊石[2] 

机构地区：[1]南京大学医学院临床学院 [2]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2010年第1期23-29,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:探讨成人特发性局灶节段性肾小球硬化的远期预后以及相关因素。方法:回顾性分析77例成人特发性局灶节段性肾小球硬化,估算Kaplan-Meier生存曲线,并就预后因素进行单因素和多因素COX回归分析。结果:77例患者平均随访(64.66±25.72)月。终末期肾病患者共17例,无人死亡。25例活检时合并急性肾衰竭的患者中7例进入终末期肾病。5年人、肾存活率分别为100%、83.8%,中位肾生存时间为(116±15.34)月(95%CI85.93,146.07)。单因素分析得出尿蛋白(HR1.147,P<0.01)、血肌酐(HR3.233,P<0.05)、小管间质慢性损伤(HR1.684,P<0.05)、治疗反应(HR5.607,P<0.01)与预后相关。多因素分析得出大量蛋白尿(HR1.327,P<0.01)、小管间质慢性损伤(HR2.161,P<0.01)、治疗反应(HR39.796,P<0.01)为预后的独立危险因素。结论:中国成人特发性局灶节段性肾小球硬化的5年肾存活率为83.8%。大量蛋白尿、小管间质慢性损伤、治疗无效为预后的独立危险因素。Objective ：To analyze the long-term outcome and prognostic factors of adult idiopathic focal segmental glomerulosclerosis （FSGS）. Methodology：Seventy seven adult patients with idopathic FSGS from the Reasarch institute of Nephrology, Jinling Hospital were investigated restrospectively. Survival Curve was estimated by Kaplan-Meier methods, risk factors of renal survival was done by Cox Regression. Results： They were 45 male and 32 female with a mean time of follow-up （64.7 ±25.7） months. Among them, 17 patients progressed to end-stage renal disease without death. 7 of 25 cases with acute renal failure at biopsy developed end - stage renal disease. The overall and renal survival rates were 100% and 83.8% at 5 years after diagnosis, and the median time of renal survival was （ 116 ± 15.3） months （95% CI 85.9, 146）. The levels of urine protein excretion （ HR 1. 147, P 〈 0. 01 ）, and serum creatinine （ HR 3. 233, P 〈 0.05 ）, chronic tubulointerstitial injury （ HR 1. 684, P 〈0. 0）, and treatment response （ HR 5. 607, P 〈0. 01 ） were significant by univariatie analysis. Massive proteinuria （ HR 1. 327, P 〈 0.01 ）, chronic tubulointerstitial injury （ HR 2. 161, P 〈 0. 05 ） and no response （ HR 37. 796, P 〈 0. 01 ） were independent risk factors by multivariate analysis. Conclusion ： The 5-year renal survival rate of adult idiopathic FSGS was 83. 8%. Massive proteinuria, chronic tubulointerstitial injury and no response were independent risk factors of prognosis.

关 键 词：局灶节段性肾小球硬化 预后 COX回归 

分 类 号：R692.6[医药卫生—泌尿科学]