抗中性粒细胞胞质抗体相关性新月体肾炎治疗反应及远期预后的影响因素  

Affecting factors on therapeutic response and long-term outcome in patients with crescentic ANCAassociated glomerulonephritis

作　　者：刘霞[1] 陈樱花[1] 刘正钊[1] 陈惠萍[1] 章海涛[1] 刘志红[1] 胡伟新[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科、国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2016年第2期113-118,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05);江苏省临床医学中心项目(BL2012007)

摘　　要：目的:探讨影响新月体型抗中性粒细胞胞质抗体(ANCA)相关性肾炎(AAGN)的治疗反应及远期预后的因素。方法:60例经肾活检诊断为新月体型AAGN(男25例,女35例),中位年龄54岁,基线平均血清肌酐(SCr)442±256.4μmol/L,根据是否需要肾脏替代治疗(RRT)分为RRT组(n=30)和非RRT组(n=30)。以治疗3月时RRT组摆脱RRT、非RRT组SCr下降≥25%定义为治疗反应良好(GR),否则为治疗无反应差(NR)。多因素COX回归分析临床及病理指标与治疗反应及远期肾存活相关性。结果:RRT组年龄、BVAS评分和SCr水平显著高于非RRT组,RRT组环状新月体占新月体的比例高于非RRT组(但无统计学差别),其他病理指标(总细胞性新月体、肾小球硬化比例)两组间均无差异。治疗3个月RRT组和非RRT组中分别有53.3%和80%的病例治疗反应为GR,分别有46.7%和20%为NR。多因素COX回归分析发现,环状体占新月体的比例是影响RRT患者能否摆脱RRT的主要因素,环状体占新月体的比例≥50%时不能摆脱RRT的风险显著增大;而在非RRT组,GR患者正常肾小球比例显著高于NR,正常肾小球比例>7%时治疗反应好的可能性显著增大。多因素COX回归分析发现需RRT及大量尿蛋白为影响远期肾脏存活率的独立危险因素。结论:环状体占新月体的比例、正常肾小球比例分别是影响需RRT和不需RRT新月体型AAGN患者治疗反应的主要因素;需RRT及大量蛋白尿是影响肾脏远期预后的主要因素,应综合临床和肾脏病理参数制定合理的治疗方案、判断预后。Objective： To investigate the affecting factors on the therapeutic response and long-term outcome in patients with crescentic ANCA-associated glomerulonephritis. Methodology： Sixty patients with crescentic AAGN patients diagnosed by renal biopsy were enrolled in this study. They were male 25,and female 30 cases,with a median age of 54 years old. The average levels of serum creatinine（ SCr） was 5. 0 ± 2. 9 mg / dl. According to whether the renal replacement therapy（ RRT） was needed,the ptients were classified into two groups： the RRT Group（ n = 30） and nonRRT Group（ n = 30）. With 3 months of treatment period,if the patients in RRT Group get rid of RRT and the Scr of the patients in non-RRT Group declines by 25% or more,the situation can be defined as good response（ GR）,otherwise,it should be reduced to no response（ NR）. Multivariate Cox regression analysis is applied to probe into the correlation between clinical as well as pathological parameters and therapeutic response and long-term outcome. Results： Age,BVAS score and SCr level of RRT Group were apparently higher than those of non-RRT Group. The ratio of the circumferential crescents in crescents was higher in RRT Group than that of non-RRT Group（ without statistical differences）. As for other pathological indexes including total cellular crescents and the ratio of sclerotic glomeruli,there were no marked differences between the above two groups. After 3 months of treatment,for 53. 3% patients in RRT Group and 80% patients in nonRRT Group,their therapeutic response is GR; for 46. 7% patients in RRT Group and 20% patients in non-RRT,their therapeutic response is NR. According to multivariate Cox regression analysis,the percentage of the circumferential crescents in crescents was the main factor affecting whether the RRT Group can get rid of RRT. When the percentage of crescents was equal or larger than 50%,there was a significant increase in the risk that the patients cannot get rid of RRT;while in the non-RRT Group,the rati

关 键 词：抗中性粒细胞胞质抗体 新月性肾炎 治疗 预后 

分 类 号：R692.3[医药卫生—泌尿科学]