糖皮质激素治疗表现为大量蛋白尿的IgA肾病患者的疗效及预后分析  

Efficiency of glucocorticoid treatment in IgA nephropathy with massive proteinuria

作　　者：陈振杰[1] 李航[1] 蔡建芳[1] 文煜冰[1] 李超[1] 邹佩美 张鑫[1] 李明喜[1] 陈丽萌[1] 李雪梅[1] 李学旺[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院肾内科,北京100730

出　　处：《中华肾脏病杂志》2017年第8期561-566,共6页Chinese Journal of Nephrology

基　　金：“十二五”国家科技支撑计划（2011BA110803）

摘　　要：目的探讨表现为大量蛋白尿IgA肾病（IgAN）患者的临床病理特点、糖皮质激素治疗反应及长期预后的差异性。方法回顾性分析2003年1月至2015年10月在北京协和医院确诊的、表现为大量蛋白尿的IgA肾病患者的临床资料。按照临床表现将患者分为：肾病综合征（。肾综）组和表现为大量蛋白尿的肾病（肾病）组，比较两组患者的临床病理特点、糖皮质激素反应性及长期预后的差异。结果共纳入156例IgAN患者（肾病者86例，肾综者70例）。表现为肾综的IgAN患者IgM沉积更为明显。糖皮质激素治疗6个月后，两组患者蛋白尿缓解程度的差异无统计学意义。Kaplan—Meier生存分析结果显示，6个月后蛋白尿缓解组的长期预后优于无缓解组（P〈0．001）。多元线性回归分析结果示，节段硬化比例与蛋白尿缓解程度呈负相关（β值=-0．330，P〈0．001）。多因素Cox回归模型显示，基线肾小球皮质密度（HR=0．45，P=0．02）、eGFR（HR=0．95，P=0．001）是肾脏不良预后的影响因素。结论表现为肾综的IgAN患者IgM沉积更为明显，糖皮质激素治疗6个月后蛋白尿缓解患者的肾脏预后更佳。肾小球皮质密度及eGFR是肾脏不良预后的影响因素。Objective To investigate the clinicopathological characteristics of IgAN patients with massive proteinuria, as well as their treatment response to glucocorticoids and long-term prognosis. Methods Clinical and pathological parameters were collected in patients diagnosed with IgA nephropathy in our hospital from Jan 2003 to Oct 2015. Patients were followed up for at least six months under the treatment with full dosage of glucocorticoids. Responses of patients with and without nephrotic syndrome were compared. Results A total of 156 patients were enrolled for the analysis （86 patients in the nephropathic proteinuria group, and 70 patients in the nephrotic syndrome group）. Patients presented with nephrotic syndrome showed higher proportion of IgM deposition in renal slides. There exited no difference in treatment response to glueocorticoids between the two groups. Patients with full or partial remission showed a better prognosis by Kaplan- Meier analysis than no remission group （P 〈 0.001）. The ratio of segmental sclerosis was negatively correlated with treatment response to glucocorticoids by multiple linear regression （β value=-0.330, P 〈 0.001）. Multivariate Cox regression model showed that glomerular density （HR=0.45, P=0.02） and eGFR （HR=0.95, P=0.001）were independent influential factors for renal survival. Conclusions Patients presented with nephrotic syndrome show higher proportion of IgM deposition in renal slides. Patients in remission after treatment with 6- month glucocorticoids present a better prognosis than no remission patients, and glomerular density as well as eGFR are independent influential factors for renal survival.

关 键 词：肾小球肾炎 IGA 蛋白尿 肾病综合征 糖皮质激素类 

分 类 号：R692.31[医药卫生—泌尿科学]