表现为微量白蛋白尿IgA肾病伴低C3血症患者的预后危险因素分析  

Risk factors analysis of prognosis of microalbuminuria IgA nephropathy patients with decreased serum C3 level

作　　者：郭宗运 李霞[1] 周世菊[1] 赵东[1] 刘金彦[1] 吴玉梅[1] 

机构地区：[1]山东省济宁市第一人民医院肾内科,272000

出　　处：《中国医师进修杂志》2016年第5期406-411,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的对表现为微量白蛋白尿IgA肾病伴低c3血症患者的临床资料以及预后进行分析，探讨低c3血症在微量白蛋白尿IgA肾病中的意义。方法分析。肾活检确诊且随访时间大于6个月的135例微量白蛋白尿IgA肾病患者的临床资料，依据血清c3水平，分为低c3组（34例）和正常c3组（101例）。以24h尿蛋白定量大于1g或肾穿刺时血清肌酐（SCr）值正常者出现SCr异常或肾穿刺时SCr异常者出现SCr升高1倍以上为随访终点，用Kaplan．Meier法分析肾脏生存率，应用Cox回归模型分析影响预后的相关危险因素。结果随访时间（53．4±21．9）个月，低c3组有27例（79．41％）、正常c3组有32例（31．68％）进入随访终点。通过Kaplan．Meier生存分析显示低c3组肾脏中位生存时间显著短于正常c3组[（46．7±9．1）个月比（68．4±9．9）个月，P=0．014]。应用Cox回归方法分析显示血清Scr异常（RR=1．147，95％CI：1．129～1．395，P=0．008）、低c3血症（RR=1．028，95％CI：0．672～1．495，P=0．039）、尿蛋白定量〉1g／24h（RR：2．066，95％ CI：1．242～3．838，P=0．006）以及肾穿刺时的病理指标Lee分级Ⅲ～Ⅴ级（RR=2．820，95％C1：1．249—5．638，P=0．041）、节段性肾小球硬化或粘连（RR=1．232，95％CI：1．065—1．520，P=0．040）、肾小管萎缩或间质纤维化（RR=2．604，95％CI：1．748～4．104，P=0．037）、毛细血管内细胞增生（RR=0．872，95％CI：0．491～1．275，P=0．042）、细胞性或细胞纤维性新月体（RR=1．528，95％CI：1．073～2．385，P=0．009）是影响IgA肾病患者预后的独立影响因素。结论伴有低c3血症表现为微量白蛋白尿IgA肾病患者的临床及病理表现更重，预后不良，对此类患者在早期积极控制微量白蛋白尿的同时，应进行密切随访及早期干预治疗。Objective To analyze the clinical and pathological data and prognosis of microalbuminuria IgA nephrology patients with decreased serum C3 level, and investigate the significance of decreased serum C3 level in microalbuminuria IgA nephrology patients. Methods Clinical and pathological data of microalbuminuria IgA nephrology patients confirmed by renal biopsy and followed up more than 6 months were reviewed. The patients were divided into decreased serum C3 level group （34 cases, 25.19%） and normal serum C3 level group （101 cases, 74.81%） according to the serum C3 level. Twenty-four hours urine protein quantitative 〉 1 g, or normal serum creatinine level turning into abnormal level at renal biopsy, or doubling of serum ereatinine level was defined as the end point of follow-up. Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by Cox regression models. Results Total of 135 microalbuminuria IgA nephrology patients were followed up successfully, with an average follow-up time （53.4 ± 21.9） months. There were 27 cases （79.41%） and 32 cases （31.68%） in the decreased serum C3 level group and the normal serum C3 level group respectively at the endpoint. Kaplan-Meier survival analysis showed that the median survival time was significantly shorter in decreased serum C3 level group compared with that in normal C3 level group： （46.7 ± 9.1） months vs. （68.4 ± 9.9） months, P =0.014. Cox regression analysis showed that abnormal serum creatinine （RR = 1.147, 95% CI： 1.129- 1.395, P = 0.008）, decreased serum C3 level （RR = 1.028, 95% CI： 0.672 - 1.495, P = 0.039）, urine protein quantitative 〉 1 g/24 h （RR = 2.066, 95% CI： 1.242 - 3.838, P = 0.006） and renal biopsy pathological indicators Lee class m - v （RR = 2.820, 95% CI： 1.249 - 5.638, P = 0.041）, glomerular sclerosis or adhesions （RR = 1.232, 95% CI： 1.065- 1.520, P = 0.040）, renal interstitial atrophy or interstitial fibrosis （RR = 2.604, 95% CI：

关 键 词：肾小球肾炎 IGA 白蛋白尿 预后 危险因素 补体C3 因素分析 统计学 

分 类 号：R692.3[医药卫生—泌尿科学]