新月体25%~50%的IgA肾病临床病理特点及预后  

The clinicopathological features and prognosis of nephropathy with a crescent ratio of 25% to 50%

作　　者：夏清清 俞东容[1] 姜飞[1] 孙旗策 汤绚丽[1] Xia Qingqing

机构地区：[1]浙江中医药大学附属杭州市中医院,310007 [2]浙江中医药大学附属第二医院,310000

出　　处：《浙江临床医学》2022年第1期40-42,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF19H270007)。

摘　　要：目的探讨新月体比例25%~50%的IgA肾病临床、病理特点及预后.方法回顾性分析2008年1月至2017年12月经肾活检确诊为IgA肾病,新月体比例≥25%且<50%的患者临床、病理特点.Kaplan-Meier法分析肾脏累积生存率,Cox回归模型分析复合终点事件的影响因素.结果共纳入患者154例,新月体比例30.0(27.8,35.7)%,尿蛋白定量1.42(0.83,2.41)g/24h,估算肾小球滤过率81.7(61.3,101.4)ml/(min·1.73m^(-2)),随访时间67.4(41.7,84.1)个月.85.7%的患者接受RASI治疗,96.8%的患者接受糖皮质激素或免疫抑制剂治疗,89.0%的患者接受中药治疗.8例(5.2%)患者进入复合终点事件,5年、10年肾脏累积生存率分别为98.2%、79.9%.终点事件组的患者高血压、尿蛋白定量、牛津分型T1/2、球性硬化比例较高,血浆白蛋白、血IgG较低(P<0.05).多因素Cox回归分析发现,尿蛋白定量、血尿酸是进展至复合终点事件的独立危险因素(P<0.05).结论以激素联合免疫抑制剂及中药为主治疗的154例新月体25%~50%的IgA肾病患者5年、10年肾脏累积生存率分别为98.2%、79.9%;尿蛋白定量、血尿酸是这部分IgA肾病患者进展至复合终点事件的独立危险因素.Objective To investigate the clinicopathological features and prognosis of IgA nephropathy with a crescent ratio of 25% to 50%.Methods The clinical and pathological features of patients with IgA nephropathy diagnosed by renal biopsy in our hospital from January 2008 to December 2017 were analyzed retrospectively.The cumulative survival rate of kidney was analyzed by Kaplan-Meier method,and the influenfactors of compound end point events were analyzed by Cox regression model.Results A total of 154 patients were included.The proportion of crescents was 30.0(27.8,35.7)%,the quantity of urinary protein was 1.42(0.83,2.41)g per 24 hour,and the estimated glomenilar filtration rate was 81.7(61.3,101.4)niL/(min·1.73 m^(-2)).The average follow-up time was 67.4(41.7,84.l)months.85.7% of the patients were treated with renin-angiotensin-inhibitor,96.8% were treated with corticosteroids or immunosuppressants,and 89.0% were treated with traditional Chinese medicine.A total of 8 patients(5.2%)entered the compound end point event,and the 5- and 10-year cumulative renal survival rates were 98.2% and 79.9%,respectively.The patients in the end event group had higher rates of hypertension,urinary protein quantity,Oxford classification T1/2 and globular sclerosis,while lower plasma albumin and blood IgG(P<0.05).Multivariate Cox regression analysis showed that urinary protein and serum uric acid were independent risk factors for progression to multiple endpoint events.Conclusion The 5-year and 10-year cumulative renal survival rates of IgA nephropathy with a crescent ratio of 25% to 50% treated with corticosteroids combined with immunosuppressants and traditional Chinese medicine are 98.2% and 79.9%,respectively.Urinary protein and serum uric acid are independent risk factors for progression to multiple endpoint events in these IgA nephropathy patients.

关 键 词：IGA肾病 新月体 临床病理 预后 

分 类 号：R73[医药卫生—肿瘤]