1126例中国汉族成人IgA肾病患者的长期预后及危险因素分析  

Long-term renal survival and related risk factors of patients with IgA nephropathy:results from a cohort of 1126 cases in a Chinese adult population

作　　者：乐伟波[1] 梁少珊[1] 邓康平[1] 胡炀琳[1] 曾彩虹[1] 刘志红[1] 

机构地区：[1]南京军区南京总医院全军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2011年第2期101-108,共8页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(81020108016)

摘　　要：目的:阐明我国汉族成人IgA肾病(IgA nephropathy,IgAN)患者的长期预后及其相关危险因素,并明确IgAN患者尿蛋白的控制目标值。方法:利用南京军区南京总医院全军肾脏病研究所IgAN随访登记数据库,分析1989年～2005年期间经肾活检确诊IgAN患者的随访资料。利用Kaplan-Meier法计算患者的累计肾脏生存率,并利用COX回归模型分析相关危险因素。结果:共1126例患者纳入本研究,中位随访时间为5.5年,88例患者(7.8%)在随访期间进入终末期肾脏病(ESRD),144例患者在随访中发生终点事件(eGFR下降50%或进入ESRD)。患者肾活检后10年、15年、20年累积肾脏生存率分别为:85%、74%、67%。多因素COX回归分析结果表明,肾活检时尿蛋白定量>1.0g/d(HR3.3,P<0.001)、血压>140/90mmHg(HR2.0,P<0.001)、eGFR<60ml/min·1.73m2(HR2.2,P<0.001)、以及高尿酸血症(血尿酸>420μmol/L,HR1.8,P=0.002)是肾脏预后的独立危险因素。随访中患者尿蛋白、血压及镜下血尿程度也与其肾脏长期预后独立相关,其中以随访中平均尿蛋白定量(time-average proteinuria,TA-P)最为重要。TA-P预测患者进入终点事件的ROC曲线下面积高达0.9,最佳截点约为1.0g/d(敏感性81%,特异性85%)。校正其他影响因素后,TA-P>1.0g/d者进入终点事件的风险较<1.0g/d者增加9.8倍(P<0.001),较<0.5g/d者增加67.7倍(P<0.001),而且TA-P介于0.5～1.0g/d者进入终点事件的风险仍较<0.5g/d者增加13.1倍(P<0.001)。结论:本研究结果表明我国成人IgAN患者10年、20年肾脏累计生存率分别为85%、67%。尿蛋白、肾功能受损程度、血压状态、高尿酸血症是患者进展至ESRD的独立危险因素。随访过程中蛋白尿持续不缓解是患者进入ESRD最主要的危险因素。中国成人IgAN患者的尿蛋白基本控制目标值为<1.0g/d,理想控制目标值为<0.5g/d。Objective： To investigate the long-term renal survival rate and related risk factors of progression to renal failure in Chinese adult patients with IgA nephropathy （IgAN） and to quantify the effects of proteinuria during the follow-up on outcome in patients with IgAN. Methodology： The patients with biopsy-proven primary IgAN in the Nanjing Glomerulonephritis Registry were studied. Renal survival and the relationships between clinical parameters and renal outcomes were assessed. Results：l 126 patients were enrolled in this study. The 10, 15, and 20-year cumulative renal survival rates, calculated by Kaplan-Meier method, were 85%, 76% and 67% respectively. At the time of biopsy, proteinuria 〉 1.0 g/d （ HR 3.3, P 〈 0. 001 ）, eGFR 〈 60 ml/min per 1.73 m2 （ HR 2. 2, P 〈 0. 001 ）, hypertension （ HR 2. 0, P 〈 0. 001 ）, and hyperuricemia （HR 1. 8 ,P = 0. 002 ） were the independent risk factors. Multivariate COX analysis showed the time-averageproteinuria （TA-P） during follow-up was the most important risk factor of renal failure. The patients with TA-P 〉 1.0 g/d were associated with a 9. 8-fold risk than that patients with TA-P 〈 1.0 g/d （P 〈0. 001 ）, and 67.7-fold risk than those with TA-P 〈0. 5 g/d （P 〈0. 001 ）. The patients with TA-P 〈0. 5 g/d were better than those with TA-P between 0. 5 and 1.0 g/d （HR 13.1, P 〈 0. 001 ）. Conclusion ：33% of Chinese adult patients with primary IgAN have progressed to End Stage Renal Disease （ESRD） within 20 years. Four clinical features--higher proteinuria, hypertension, impaired renal function, and hyperuricemia are independent predictors of an unfavorable renal outcome. The basic goal of antiproteinuric therapy for Chinese patients is to lower proteinuria to 〈 1.0 g/d, and the optimal goal is to lower proteinuria to 〈0. 5 g/d.

关 键 词：IGA肾病 肾脏累计生存率 危险因子 尿蛋白 

分 类 号：R692[医药卫生—泌尿科学]