并发急性肾损伤的特发性膜性肾病病人临床特征分析  

CLINICAL CHARACTERISTICS OF PATIENTS WITH IDIOPATHIC MEMBRANOUS NEPHROPATHY WITH ACUTE KIDNEY INJURY

作　　者：高升波 范娟 娄兴华 王明秋 蒋伟[1] GAO Shengbo;FAN Juan;LOU Xinghua;WANG Mingqiu;JIANG Wei(Department of Nephrology,The Affi-liated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院肾内科,山东青岛266003 [2]昌乐县人民医院肾内科

出　　处：《青岛大学学报（医学版）》2022年第4期567-570,共4页Journal of Qingdao University(Medical Sciences)

基　　金：中华医学会-施维雅肾脏病研究与发展项目(2001-0080800)。

摘　　要：目的探讨并发急性肾损伤(AKI)的特发性膜性肾病(IMN)病人的临床特征,为其临床诊疗提供理论依据。方法选择2016年1月—2019年12月在青岛大学附属医院住院并经肾穿刺活检术确诊的IMN病人176例,根据是否发生AKI,分为AKI组(58例)和非AKI组(118例)。分析两组临床资料的特征差异,并采用二分类Logistic回归模型分析IMN病人发生AKI的危险因素。结果与非AKI组相比,AKI组以高龄、男性病人为主,有高血压、冠心病、脑卒中史者的比例更高,尿素、肌酐(SCr)、尿酸、同型半胱氨酸(Hcy)和抗磷脂酶A2受体(PLA2R)抗体水平显著升高,差异有统计学意义( χ^(2)=4.22~5.42,t=4.20~5.12,P<0.05)。SCr水平与Hcy和抗PLA2R抗体水平呈正相关关系(r=0.288、0.230,P<0.05)。二分类Logistic回归分析显示,年龄(OR=6.500,95%CI=1.652~10.540,P=0.002)、Hcy水平(OR=19.992,95%CI=1.233~46.011,P<0.001)和抗PLA2R抗体滴度(OR=2.820,95%CI=1.676~4.011,P=0.001)是IMN病人发生AKI的独立影响因素。治疗后,与AKI非改善组相比,AKI改善组病人Hcy水平和抗PLA2R抗体滴度显著降低,差异有统计学意义(t=6.36、5.42,P<0.01)。结论IMN病人AKI发生率高,高Hcy血症和抗PLA2R抗体滴度升高增加IMN病人发生AKI的风险。Objective To explore the clinical characteristics of patients with idiopathic membranous nephropathy(IMN)with acute kidney injury(AKI),and to provide a theoretical basis for their clinical diagnosis and treatment.Methods We selec-ted 176 patients with a confirmed diagnosis of IMN by renal needle biopsy who were hospitalized in The Affiliated Hospital of Qingdao University from January 2016 to December 2019.The patients were divided into AKI group(58 cases)and non-AKI group(118 cases)based on whether AKI occurred.The clinical data were compared between the two groups.The risk factors for AKI in patients with IMN were analyzed using a binary Logistic regression model analysis.Results Compared with the non-AKI group,the AKI group had a significantly older age,a significantly higher percentage of male patients,significantly higher percentages of patients with hypertension,coronary heart disease,and cerebral stroke,and significantly higher levels of serum urea nitrogen,creatinine(Cr),uric acid,homocysteine(Hcy),and anti-phospholipase A2 receptor(PLA2R)antibody( χ^(2)=4.22-5.42,t=4.20-5.12,P<0.05).The serum Cr level was positively correlated with Hcy and anti-PLA2R antibody levels(r=0.288,0.230;P<0.05).The binary Logistic regression analysis showed that age(OR=6.500,95 CI=1.652-10.540,P=0.002),Hcy level(OR=19.992,95%CI=1.233-46.011,P<0.001),and anti-PLA2R antibody level(OR=2.820,95%CI=1.676-4.011,P=0.001)were independent risk factors for AKI in patients with IMN.After treatment,patients with AKI with improvement showed significantly decreased Hcy and anti-PLA2R antibody levels than those without improvement(t=6.36,5.42;P<0.01).Conclusion The incidence of AKI in patients with IMN is high.Increased Hcy and anti-PLA2R antibody levels are independent risk factors for AKI in patients with IMN.

关 键 词：肾小球肾炎 膜性 急性肾损伤 疾病特征 半胱氨酸 抗PLA2R抗体 

分 类 号：R692.31[医药卫生—泌尿科学]