IgA肾病伴不同比例新月体患者的临床病理特征及预后分析  

Clinicopathological features and prognosis of IgA nephropathy with different proportions of crescentic lesions

作　　者：孙旗策 俞东容[1] 陈洪宇[1] 朱斌[1] 胡云琴[1] 姜飞[1] 吴军[1] 王永钧[1] SUN Qice;YU Dongrong;CHEN Hongyu;ZHU Bin;HU Yunqin;JIANG Fei;WU Jun;WANG Yongjun(Department of Nephrology, Guangxing Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou, 310053)

机构地区：[1]浙江中医药大学附属广兴医院肾内科,浙江杭州310053

出　　处：《温州医科大学学报》2017年第3期201-205,共5页Journal of Wenzhou Medical University

基　　金：浙江省中医药重大疾病科技创新平台科研专项(2009ZDJB02);浙江省科技计划项目(2012C33032)

摘　　要：目的:探讨IgA肾病(IgAN)伴不同比例新月体患者的临床、病理特征及预后。方法:回顾性分析2001年1月至2007年12月在本院经肾活检确诊为原发性IgAN的患者1 054例,根据光镜下有无新月体形成及新月体累及肾小球的比例将患者分为4组,组1:新月体比例≤10%(n=271);组2:10%<新月体比例≤25%(n=182);组3:新月体比例>25%(n=46);对照组:无新月体形成(n=555)。比较4组间临床、病理特征及预后情况,采用Kaplan Meier方法进行生存分析,单因素及多因素Cox风险回归模型分析新月体对IgAN的预后价值。结果:本研究共1 054例患者成功进行随访,新月体平均百分比为13.2%±15.7%。肾穿前血红蛋白(HB)、血肌酐(Scr)、血浆白蛋白(ALB)、胆固醇(Tc)、甘油三酯(Tg)、24 h尿蛋白和估算的肾小球滤过率(e GFR)等临床指标在组间的差异均有统计学意义(P<0.05)。肾小球系膜增殖、袢坏死等活动性病理指标及节段性肾小球硬化、肾小管萎缩/间质纤维化等慢性病理改变在对照组最轻,随着新月体比例增加,病变程度进一步加重(P<0.05)。中位随访时间90.0(62.1,113.7)个月,114例(占10.8%)患者进入终点事件,Kaplan Meier生存分析结果示4组生存率组间比较差异有统计学意义(χ~2=13.35,P<0.01)。在单因素及多因素Cox比例风险回归模型中,只有新月体比例>25%与发展到终点事件的风险存在显著关联(P<0.05)。结论:新月体与IgAN患者临床、病理特征存在一定相关性,在一定程度上可以反映疾病进展的程度。新月体比例>25%是疾病进展至终末期肾病的独立危险因素。Objective: To explore the clinicopathologic features and prognosis of IgA nephropathy (IgAN) with different proportions of crescentic lesions. Methods: In total, 1 054 patients who underwent renal biopsy in our hospital from January 2001 to December 2007 were enrolled. We grouped the patients as follows, based on the proportion of crescentic lesions at diagnosis: mild group (≤10%, n=271), moderate group (>10% to ≤25%,n=182), and severe group (>25%, n=46), and control group (no crescent formations, n=555). Renal survival curves were generated with the Kaplan Meier method. Univariate and multivariate Cox regression model was used to analysis the prognostic value of crescent in IgAN. Results: Of the 1 054 subjects, mean proportion of crescent was 13.2%±15.7%. The proportion of crescents was significantly correlated with the urine protein concentration,serum creatinine concentration, estimated glomerular filtration rate, cholesterol, triglyceride, albumin,and hemoglobin concentration (P<0.05). Pathological indices, such as mesangial proliferation, glomerular sclerosis,and chronic pathological changes (e.g., tubular atrophy/interstitial fibrosis) showed significant differences among the four groups; an increased crescent proportion was especially pathologic (P<0.05). Renal failure was observed in 114 (10.8%) patients at a median of 90.0 months (interquartile range: 62.1-113.7 months). Kaplan Meier analysis revealed that the cumulative renal survival also significantly differed among the four groups (χ2=13.35, P<0.01). In the univariate and multivariable Cox hazards regression, only a higher proportion of crescentic lesions (>25%) had a higher predictive value (P<0.05). Conclusion: The correlation between crescentic lesions and clinicopathologic features in patients with IgAN reflects the degree of disease progression. A higher proportion of crescentic lesions (>25%) in these patients is an independent risk factor for progression to renal failure.

关 键 词：新月体 肾小球肾炎 IgA 预后 病理学 临床 

分 类 号：R446.8[医药卫生—诊断学]