单中心特发性膜性肾病复发情况及复发危险因素分析  

Analysis of Recurrence and Risk Factors of Single-center Idiopathic Membranous Nephropathy

作　　者：袁卓杰 洪伟武 洪晓帆 刘娟[2] 林文秋[2] 梁星[2] 林嘉荣 徐鹏[2] 包崑[2] YUAN Zhuo-jie;HONG Wei-wu;HONG Xiao-fan;LIU Juan;LIN Wen-qiu;LIANG Xing;LIN Jia-rong;XU Peng;BAO Kun(Shantou Central Hospital,Shantou Guangdong 515031,China;Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou Guangdong 510120,China)

机构地区：[1]汕头市中心医院,广东汕头515031 [2]广东省中医院,广东广州510120

出　　处：《中医药导报》2021年第10期104-109,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：省部共建中医湿证国家重点实验室(广州中医药大学第二附属医院)专项课题(SZ2020ZZ18);广东省中医药防治难治性慢病重点实验室(2018年度)专项课题(2018B030322012);国家自然科学基金面上项目(81974565)。

摘　　要：目的:探讨215例治疗后缓解的特发性膜性肾病患者的临床特征及复发情况,分析复发相关危险因素。方法:回顾性分析215例治疗后缓解的特发性膜性肾病患者,根据复发情况分为复发组及未复发组,统计分析复发患者的临床特征,对比分析两组患者活检时及缓解时的临床资料,采用Cox回归分析,总结复发相关危险因素。结果:特发性膜性肾病总复发率为31.60%(68/215),男性复发率为34.20%(38/111),女性复发率为28.80%(30/104);复发患者中完全缓解、随访过程中存在感染、未使用静脉环磷酰胺联合糖皮质激素、他克莫司联合糖皮质激素、缓解后未使用中药满3个月占比均高于未复发患者。多因素Cox分析表明,部分缓解[HR=0.528,95%CI(0.307,0.905)]、治疗过程中使用环磷酰胺联合糖皮质激素[HR=0.451,95%CI(0.273,0.744)]及缓解后继续使用中药3个月以上[HR=0.511,95%CI(0.309,0.844)]为复发的独立保护因素。结论:本院特发性膜性肾病复发率为31.60%(68/215),主要集中在51~70岁,完全缓解为特发性膜性肾病复发的独立危险因素,部分缓解、免疫抑制剂类型选用环磷酰胺联合糖皮质激素、缓解后继续使用中药超过3个月为复发独立保护因素。Objective:To explore the clinical characteristics and recurrence of 215 patients with idiopathic membranous nephropathy,then to analyze the risk factors related to recurrence.Methods:In this retrospective analysis,215 patients with idiopathic membranous nephropathy who were relieved after treatment were divided into relapse group and non-relapse group according to the relapse status.The author compared and analyzed the clinical data between the relapsed group and the non-relapsed group at the different time of biopsy and remission,and summarized the risk factors related to relapse using Cox regression analysis.Results:The total recurrence rate was 31.60%(68/215),the recurrence rate for men was 34.20%(38/111)and 28.80%(30/104)for women.The proportion of complete remission,no use of hormone with intravenous cyclophosphamide,use hormone with tacrolimus,no continued use of Chinese medicine for 3 months after remission was higher than that of the non-relapse group.COX analysis showed that:partial remission[HR=0.511,95%CI(0.309,0.905)],the use of hormone with cyclophosphamide[HR=0.451,95%CI(0.273,0.744)],remission continued use of Chinese medicine for more than 3 months was the independent protective factor for relapse[HR=0.511,95%CI(0.309,0.844)].Conclusion:The recurrence rate of idiopathic membranous nephropathy in our hospital is 31.60%(68/215),which is mainly distributed over the age of 51-70 year-old,Complete remission is an independent risk factor for the recurrence of idiopathic membranous nephropathy.The type of immunosuppressive agent hormone with cyclophosphamide,and continued use of Chinese medicine for more than 3 months after remission is an independent protective factor for relapse.

关 键 词：特发性膜性肾病 复发 危险因素 保护因素 免疫抑制剂 环磷酰胺 糖皮质激素 中药 COX回归 

分 类 号：R259[医药卫生—中西医结合]