肾小球硬化与特发性膜性肾病患者肾脏预后的相关性  

Correlation between glomerulosclerosis and renal prognosis in patients with idiopathic membranous nephropathy

作　　者：韦翠美 何永成[2] 李彤[2] 肖小华[1] 程媛 陈嘉[2] 齐东丽[2] 关米洁 许日聪 WEI Cui-mei;HE Yong-cheng;LI Tong;XIAO Xiao-hua;CHENG Yuan;CHEN Jia;QI Dong-li;GUAN Mi-jie;XU Ri-cong(Department of Geriatrics,the First Affiliated Hospital of Shenzhen University,Shenzhen 518000,Guangdong,CHINA;Department of Nephrology,Shenzhen Second People's Hospital,Shenzhen 518000,Guangdong,CHINA)

机构地区：[1]深圳大学第一附属医院老年医学科,广东深圳518000 [2]深圳市第二人民医院肾内科,广东深圳518000

出　　处：《海南医学》2020年第15期1935-1940,共6页Hainan Medical Journal

基　　金：广东省深圳市科创委基础研究项目(编号:JCYJ20130329104904512);广东省深圳市科创委技术开发项目(编号:CXZZ20140421155346007);广东省深圳市科创委技术开发项目(编号:CXZZ20150601140615135);广东省深圳市科技计划项目(编号:JCY20180507184647636)。

摘　　要：目的探讨不同程度肾小球硬化[肾小球节段硬化(FSGS)和/或球性硬化]比例与特发性膜性肾病(IMN)患者肾脏预后的关系。方法回顾性分析2008年1月至2017年12月在深圳大学第一附属医院经肾活检确诊为IMN患者200例,比较不同肾小球硬化比例患者临床病理及其与预后的差异。以eGFR下降20%、终末期肾病(ESRD)或全因死亡作为随访终点事件。结果200例IMN患者中,伴有FSGS和/或球性硬化者共84例,占42%;与肾小球硬化比例<6.45%组比较,肾小球硬化比例≥6.45%组患者的血尿素氮、血清肌酐、甘油三脂偏高,而eGFR较低,差异均有统计学意义(P=0.023);与肾小球硬化比例<6.45%组比较,肾小球硬化比例≥6.45%组患者的肾脏病理损害更重,其肾间质炎症细胞浸润比例、肾小管萎缩比例以及肾小动脉增厚比例更高,差异均有统计学意义(P<0.05);与肾小球硬化比例<6.45%组比较,肾小球硬化比例≥6.45%组患者Ⅰ期及Ⅰ~Ⅱ期膜性肾病的比例较高,肾小球硬化比例高的患者多集中在Ⅰ期、Ⅰ~Ⅱ期,差异有统计学意义(P<0.05);肾小球硬化比例与eGFR呈负相关(r=-0.330,P<0.05);Logistic回归分析结果显示,肾小管萎缩[OR=4.05,95%CI=(1.90,8.63),P=0.0003]、肾间质炎症细胞浸润[OR=2.45,95%CI=(1.03,5.80),P=0.0422]是肾小球硬化形成的独立相关因素(P<0.05);K-M生存曲线显示,肾小球硬化比例≥6.45%的IMN患者的肾脏预后较差(P<0.05);COX回归分析矫正混杂因素后提示,随着肾小球硬化比例增加,发生肾脏结局事件的风险也增加。结论肾小球硬化形成是IMN患者肾功能进展及肾脏预后不良的危险因素,随着肾小球硬化比例增加,发生肾脏终点事件的风险呈逐渐增加趋势。Objective To investigate the relationship between the ratio of glomerulosclerosis(glomerular segmental sclerosis[FSGS]and/or glomerulosclerosis)and renal prognosis in patients with idiopathic membranous nephropathy(IMN).Methods A total of 200 patients,who were diagnosed as IMN by renal biopsy from January 2008 to December 2017 in the First Affiliated Hospital of Shenzhen University,were enrolled.The clinical pathology and prognosis were compared between the patients with different glomerulosclerosis ratio.The end point of follow-up was the decrease of eGFR by 20%,end-stage renal disease(ESRD)or all-cause death.Results Among the 200 patients,there were 84 patients with FSGS and/or glomerulosclerosis,accounting for 42%.Compared with patients with glomerulosclerosis ratio<6.45%,the levels of blood urea nitrogen,serum creatinine,and triglyceride in patients with glomerulosclerosis ratio≥6.45%were higher,while EGFR was lower(P=0.023);patients with glomerulosclerosis ratio≥6.45%have more severe pathological damage to the kidney,higher proportion of renal interstitial inflammatory cell infiltration,higher proportion of tubular atrophy,and higher proportion of renal arteriolar thickening;patients with glomerular sclerosis≥6.45%had higher proportion of stageⅠand stageⅠtoⅡmembranous nephropathy,and the patients with high glomerulosclerosis ratio were concentrated in stageⅠand stageⅠtoⅡ(P<0.05).The glomerulosclerosis ratio is negatively correlated with eGFR(r=-0.330,P<0.05).Logistic regression analysis showed that renal tubular atrophy(OR=4.05,95%CI=[1.90,8.63],P=0.0003),renal interstitial inflammatory cell infiltration(OR=2.45,95%CI=[1.03,5.80],P=0.0422)were the independent related factors of the formation of glomerulosclerosis(P<0.05).Kaplan-Meier analysis showed that renal prognosis of IMN patients with glomerulosclerosis ratio≥6.45%was poor(P<0.05).Cox regression analysis showed that the risk of renal outcome events increased with the increase of glomerulosclerosis.Conclusion Glomerulosclerosis is a

关 键 词：特发性膜性肾病 肾小球硬化 肾小球节段硬化 相关性 预后 

分 类 号：R692[医药卫生—泌尿科学]