血尿转归与中等量蛋白尿型IgA肾病预后的相关性分析  

Analysis of the correlation between hematuria outcome and the prognosis of IgA nephropathy with moderate proteinuria

作　　者：孙慧 韦婵[1,2] 徐道亮 刘昌华[2] 周刚[2] 高波[2] SUN Hui;WEI Chan;XU Daoliang;LIU Changhua;ZHOU Gang;GAO Bo(School of Medicine,Yangzhou University,Yangzhou 225009;Nephrology Department,Subei People's Hospital of Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]扬州大学医学院,江苏扬州225009 [2]江苏省苏北人民医院肾内科,江苏扬州225001

出　　处：《临床医学研究与实践》2022年第23期23-26,35,共5页Clinical Research and Practice

摘　　要：目的探讨血尿转归对伴有中等量蛋白尿免疫球蛋白A肾病(简称IgA肾病,IgAN)患者预后的评估价值。方法选取2015年10月至2019年7月经肾活检确诊为原发性IgAN的126例患者为研究对象,根据随访结束后计算所得的时间平均尿液红细胞数(TA-H)水平是否较基线值下降50%以上将其分成血尿无缓解组(A组)和血尿缓解组(B组)。比较两组的基线资料和随访特征;分析两组的联合终点事件和生存情况;观察联合终点事件危险因素的Cox回归分析结果。结果A组的平均动脉压(MAP)和血红蛋白(Hb)水平高于B组,尿液红细胞数(U-RBC)和新月体占比低于B组(P<0.05);A组的TA-H、时间平均蛋白尿(TA-P)、时间平均血肌酐(TA-SCr)水平、时间平均性平均动脉压(TA-MAP)高于B组,时间平均白蛋白(TA-ALB)水平和时间平均估算肾小球滤过率(TA-eGFR)低于A组(P<0.05);A组使用免疫抑制剂患者占比低于B组(P<0.05)。A组的联合终点事件发生率高于B组(P<0.05);随访结束时TA-H的最佳cut-off值为45.65个/μL;单因素Cox回归分析结果显示,TA-H>45.65个/μL患者达到联合终点的概率是TA-H<45.65个/μL患者的4.778倍(95%CI 2.057~11.100,P=0.000);Kaplan-Meier分析进一步证实,A组的终点事件发生时间短于B组(P<0.05)。多变量Cox回归分析结果反映血尿控制程度是IgAN转归的独立危险因素。结论血尿的缓解可延迟IgAN进展并减少不良肾脏结果的发生,其转归情况或可成为评估患者预后的一项指标。Objective To explore the evaluation value of hematuria outcome in prognosis of immunoglobulin A nephropathy(IgA nephropathy for short,IgAN)patients with moderate proteinuria.Methods A total of 126 patients with primary IgAN diagnosed by renal biopsy from October 2015 to July 2019 were selected as the research objects.According to whether the time-averaged hematuria(TA-H)level calculated after the end of the follow-up decreased by more than 50%from the baseline value,the patients were divided into hematuria without remission group(group A)and hematuria remission group(group B).The baseline data and follow-up characteristics of the two groups were compared;the combined end point events and survival condition of the two groups were analyzed;Cox regression analysis results of the risk factors of combined end point events was observed.Results The mean arterial pressure(MAP)and hemoglobin(Hb)level in the group A were higher than those in the group B,the urine red blood cell count(U-RBC)and the proportion of crescentic bodies were lower than those in the group B(P<0.05);TA-H,time-averaged proteinuria(TA-P),time-averaged serum creatinine(TA-SCr)levels and time-averaged mean arterial pressure(TA-MAP)in the group A were higher than those in the group B,the level of time-averaged albumin(TA-ALB)and time-averaged estimated glomerular filtration rate(TA-eGFR)were significantly lower than those in the group A(P<0.05);the proportion of patients using immunosuppressants in the group A was lower than that in the group B(P<0.05).The incidence of combined end point events in the group A was higher than that in the group B(P<0.05);at the end of follow-up,the optimal cut-off value of TA-H was 45.65/μL;univariate Cox regression analysis results showed that the probability of reaching the combined end point in patients with TA-H>45.65/μL was 4.778 times more than that in patients with TA-H<45.65/μL(95%CI 2.057-11.100,P=0.000);Kaplan-Meier analysis further confirmed that the time of end point events in the group A was shorter than th

关 键 词：血尿 中等量蛋白尿 IGA肾病 

分 类 号：R692.6[医药卫生—泌尿科学]