微小病变肾病患者发生急性肾小管坏死的临床特点及相关因素  

Clinical characteristics and related factors of acute tubular necrosis in patients with minimal change disease

作　　者：林淑芃[1] 孟金铃 孙晓伟 崔敬[1] 梁爽[1] 尹忠[1] 孙雪峰[1] 陈仆[1] Lin Shupeng;Meng Jinling;Sun Xiaowei;Cui Jing;Liang Shuang;Yin Zhong;Sun Xuefeng;Chen Pu(Department of Nephrology,Chinese PLA General Hospital,Chinese PLA Institute of Nephrology,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Chronic Kidney Diseases,Beijing 100853,China)

机构地区：[1]解放军总医院肾脏病科,解放军肾脏病研究所,肾脏疾病国家重点实验室,国家慢性肾病临床医学研究中心,北京100853

出　　处：《中华医学杂志》2020年第44期3494-3497,共4页National Medical Journal of China

基　　金：国家重点研发计划(2016YFC0906202)。

摘　　要：目的:探讨微小病变肾病(MCD)患者发生急性肾小管坏死(ATN)的临床特点及相关因素。方法:回顾性收集解放军总医院2013年1月1日至2019年12月31日病理诊断为MCD,临床表现为肾病综合征的患者资料。分析其临床及病理指标,比较不同年龄段ATN的发生率及其临床特点。采用多因素logistic回归模型分析与ATN发生相关的影响因素。结果:共纳入525例患者,男女比例为1.56∶1,年龄33(21,48)岁。525例MCD患者中49例发生ATN,发生率为9.3%。其中男34例,女15例。≤20、21~40、41~60、>60岁年龄段MCD患者ATN发生率分别为2.4%(3/123)、5.2%(10/192)、13.2%(20/152)和27.6%(16/58),ATN的发生率随年龄增加呈升高趋势(χ^2=31.442,P<0.001)。MCD患者中丙氨酸转氨酶(ALT)>40 U/L共92例(17.5%),天冬氨酸转氨酶(AST)>40 U/L共53例(10.1%),γ-谷氨酰转移酶(GGT)>50 U/L共99例(18.9%),血清IgE升高患者共303例(57.7%)。与非ATN组相比,ATN组患者年龄更大,ALT、血肌酐、血尿素氮水平更高,合并糖尿病、高血压比例更高(均P<0.05),其他临床指标差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,年龄>40岁(OR=6.283,95%CI:2.695~14.649,P<0.001)和血清白蛋白低(OR=0.924,95%CI:0.857~0.997,P=0.040)与MCD患者发生ATN独立相关。结论:年龄>40岁是MCD患者发生ATN的独立相关因素,血清白蛋白是发生ATN的保护性因素。Objective To investigate the clinical characteristics and related factors of acute tubular necrosis(ATN)in patients with minimal change disease(MCD).Methods Patients from Chinese PLA General Hospital who were pathologically diagnosed with MCD and had clinical manifestations of nephrotic syndrome from January 1,2013 to December 31,2019 were included.The clinical and pathological data of patients were retrospectively analyzed.Meanwhile,the incidence and clinical characteristics of ATN in different age groups were compared.The risk factors for ATN were assessed using binary logistic regression.Results A total of 525 patients were included,with a gender ratio of 1.56∶1(male:female),aged 33(21,48)years old.ATN occurred in 49(9.3%)of 525 patients,of which 34 were male and 15 were female.The incidence of ATN increased with age in MCD patients of different age groups(χ^2=31.442,P<0.001).The incidence of ATN in groups of age≤20 years,21-40 years,41-60 years,and>60 years was 2.4%(3/123),5.2%(10/192),13.2%(20/152)and 27.6%(16/58),respectively.Elevations of alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT)and serum IgE occurred in 92 patients(17.5%),53 patients(10.1%),99 patients(18.9%),and 303 patients(57.7%),respectively.There were significant differences in age,ALT,serum creatinine,serum urea nitrogen,history of diabetes and history of hypertension between non-ATN group and ATN group(all P<0.05).The results of logistic regression analysis showed that>40 years old(OR=6.283,95%CI:2.695-14.649,P<0.001)and serum albumin(OR=0.924,95%CI:0.857-0.997,P=0.040)was independently associated with ATN in MCD patients.Conclusion Age>40 years is an independent risk factor and serum albumin is a protective factor for ATN in MCD patients.

关 键 词：肾病 脂性 微小病变肾病 肾病综合征 肾小管坏死 急性 危险因素 

分 类 号：R692[医药卫生—泌尿科学]