原发性局灶节段性肾小球硬化症的病理亚型与临床疗效的相关性分析  

Correlation between pathological subtypes of focal segmental glomerulosclerosis and clinical efficacy

作　　者：王羽 吴超[2] 汪裕伟[3] 李洪飞 WANG Yu;WU Chao;WANG Yuwei;LI Hongfei(Department of Hemodialysis Center,the Second Affiliated Hospital of Wannan Medical College,Wuhu 241002,China;Department of Pathophysiology,Wannan Medical College;Department of Nephrology,Yijishan Hospital,Wannan Medical College;Shenyang 15th Retired Cadres′Center of Liaoning Province Military Commnd)

机构地区：[1]皖南医学院第二附属医院肾内科,安徽芜湖241002 [2]皖南医学院病理生理学教研室 [3]皖南医学院弋矶山医院肾内科 [4]辽宁省军区沈阳第十五离职干部休养所

出　　处：《沈阳医学院学报》2023年第3期238-242,共5页Journal of Shenyang Medical College

基　　金：安徽省高校科学研究项目(No.KJ2020A0604);安徽省重点研究与开发计划项目(No.S202104j07020117);皖南医学院校级中青年项目(No.WK2021F41)。

摘　　要：目的:分析原发性局灶节段性肾小球硬化症(FSGS)患者的病理亚型对患者临床疗效的影响以及探讨影响患者临床疗效的独立危险因素。方法:选择2011年7月至2018年10月皖南医学院弋矶山医院收治的经肾活检确诊为FSGS患者126例为研究对象,通过患者肾活检结果以及临床检查结果分析FSGS患者病理亚型(非特殊型、门部型、细胞型、顶端型及塌陷型)对治疗后是否缓解的影响,通过Logistic回归分析来探讨影响FSGS患者治疗后缓解率的因素。结果:FSGS患者24 h尿蛋白定量,塌陷型患者最高,而细胞型患者最低(P<0.05)。FSGS患者血清白蛋白在总体分布上差异无统计学意义(P>0.05)。FSGS患者中临床表现为血尿的患者共有71例,非特殊型患者人数最多(P<0.05)。FSGS塌陷型患者肾小球滤过率(GFR)最低,非特殊型患者GFR最高(P<0.05)。FSGS患者缓解情况结果显示,非特殊型患者的缓解率最高能达到62.5%,门部型和顶端型其次,分别为56.2%、52.0%,细胞型和塌陷型患者疗效较差,缓解率为44.4%和25.0%,但总体比较差异无统计学意义(P>0.05)。Logistic回归分析结果表明,性别是影响FSGS患者临床疗效的独立危险因素,男性患者疗效要优于女性患者(OR=0.291,P<0.01);患者是否有血尿是影响FSGS患者临床疗效的独立危险因素,有血尿患者疗效比无血尿患者要好(OR=0.286,P<0.01);FSGS患者年龄、病理亚型、高血压、尿蛋白、活检时血肌酐水平、血清白蛋白不是影响患者临床疗效的独立危险因素(P>0.05)。结论:芜湖市FSGS患者以男性患者为主,病理亚型以非特殊型最多,塌陷型最少,非特殊型和塌陷型患者发病年龄较小,门部型、顶端型以及细胞型患者发病年龄较大。患者性别以及是否表现有血尿是影响FSGS患者临床疗效的独立危险因素。Objective:To analyze the influence of pathological subtypes on clinical efficacy in patients with primary focal segmental glomerulosclerosis(FSGS)and to explore the independent risk factors affecting clinical efficacy.Methods:A total of 126 patients diagnosed as FSGS by renal biopsy at Yijishan Hospital from Jul 2011 to Oct 2018 were collected.The influence of pathological subtypes on the prognosis of FSGS patients was analyzed.Finally,logistic regression analysis was used to explore the independent risk factors affecting the prognostic remission rate of FSGS patients.Results:The quantity of 24 h urinary protein in patients with FSGS was the highest in patients with collapse type and the lowest in patients with cellular type(P<0.05).There was no significant difference in the overall distribution of serum albumin in patients with FSGS(P>0.05).Among the patients with FSGS,there were 71 patients with hematuria,and the number of patients with non-special type was the largest(31 cases)(P<0.05).The glomerular filtration rate(GFR)of patients with FSGS collapse type was the lowest,while that of non-special type was the highest(P<0.05).The results of remission of FSGS patients showed that the highest remission rate of non-special type patients was 62.5%,followed by portal type and apical type,which were 56.2%and 52.0%,respectively.The curative effect of patients with cellular type and collapse type was poor,the remission rate was 44.4%and 25.0%.However,there was no significant difference in the remission of each pathological subtype(P>0.05).The results of logistic regression analysis showed that gender and hematuria were independent risk factors affecting the clinical efficacy of FSGS patients,the curative effect of male patients was better than that of female patients(OR=0.291,P<0.01),and the curative effect of patients with hematuria was better than that of patients without hematuria(OR=0.286,P<0.01).Age,pathological subtype,hypertension,urinary protein,serum creatinine level at the time of biopsy and serum albumin in p

关 键 词：局灶节段性肾小球硬化 病理亚型 缓解率 独立危险因素 

分 类 号：R277.5[医药卫生—中医学]