免疫抑制剂对肾功能不全的免疫球蛋白A肾病患者的疗效研究  

Study on the effectiveness of immunosuppressive agents in immunoglobulin A nephropathy patients with renal insufficiency

作　　者：陈姣姣 崔文 周钰昆 王婷 王莉[1] 尚进[1] 赵占正[1] Chen Jiaojiao;Cui Wen;Zhou Yukun;Wang Ting;Wang Li;Shang Jin;Zhao Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾脏内科,河南郑州450052

出　　处：《实用药物与临床》2023年第9期785-791,共7页Practical Pharmacy and Clinical Remedies

基　　金：国家自然科学基金(81873611)。

摘　　要：目的观察免疫抑制剂对肾功能不全的免疫球蛋白A肾病(Immunoglobulin A nephropathy,IgAN)患者的疗效。方法对2012年1月1日至2021年7月1日于郑州大学第一附属医院经活检确诊的129例IgAN患者[eGFR≤60 ml/(min·m^(2))]进行回顾性研究。其中,70例患者应用非免疫抑制剂治疗(非免疫抑制剂组),59例患者应用免疫抑制剂治疗(免疫抑制剂组)。采用IgAN牛津评分系统(MEST评分)评估两组肾脏病理结果,并采用卡方检验对两组病理结果进行比较。主要终点事件定义为eGFR下降超过40%、肾移植、血液透析、腹膜透析或死亡。安全性结局包括新发糖尿病、骨折、严重感染和心血管事件,并采用卡方检验或Fisher精确检验对其进行分析。结果共有129例患者进入最终分析。两组的肾脏病理MEST评分比较差异无统计学意义(P>0.05)。两组的中位随访时间为6个月,44例(34%)患者达到了主要结局(即主要终点事件),非免疫抑制剂组有28例(40%)患者达到主要结局,免疫抑制剂组有16例(27%)患者达到主要结局。免疫抑制剂组中,高eGFR组的累积生存率优于低eGFR组(P<0.05)。免疫抑制剂组的累积生存率与非免疫抑制剂组比较差异无统计学意义(P>0.05),但免疫抑制剂组的安全性结局事件发生率高于非免疫抑制剂组。结论加用免疫抑制剂并不能改善肾功能不全的IgAN患者的预后。与eGFR低的患者相比,eGFR高的患者使用免疫抑制剂的累积生存率更高。Objective To observe the effect of immunosuppressive agents on immunoglobulin A nephropathy(IgAN)patients with renal insufficiency.Methods A retrospective study was conducted on 129 biopsy-confirmed IgAN patients who had an eGFR equal to or less than 60 ml/(min·m^(2))in the Affiliated Hospital of ZhengZhou University from January 1,2012 to July 1,2021.Seventy patients with renal insufficiency were treated with non-immunosuppressive agents and 59 patients were treated with immunosuppressive agents.IgAN Oxford scoring system(MEST)was used to assess the renal pathology results in the two groups,and chi-square test was used to compare the pathology results between the two groups.The primary endpoint events were defined as an over 40%decrease in eGFR,kidney transplantation,hemodialysis,peritoneal dialysis,or death.Safety outcomes included new-onset diabetes,fractures,serious infections,and cardiovascular events,and were analyzed using the chi-square test or Fisher′s exact test.Results A total of 129 patients were enrolled in the final analysis.There was no significant difference in renal pathology results between the two groups.With a median follow-up of six months in both groups,44(34%)patients in the two groups achieved the primary outcome(the primary endpoint event),28(40%)patients in the non-immunosuppressive group,and 16 patients(27%)in the immunosuppressive group.In the immunosuppressive group,the cumulative survival rate in the high eGFR group was better than that in the low eGFR group(P<0.05).The cumulative survival rate in the immunosuppressive group was no better than the non-immunosuppressive group(P>0.05).However,the incidence of safety outcome events in the immunosuppressive group was higher than that in the non-immunosuppressive group.Conclusion Adding immunosuppressive agents does not improve the outcome of IgAN patients with renal insufficiency.Compared to patients with low eGFR,cumulative survival rate with immunosuppressive agents is higher in patients with high eGFR.

关 键 词：肾小球肾炎 免疫球蛋白A 免疫抑制剂 肾素-血管紧张素系统 糖皮质激素 

分 类 号：R692[医药卫生—泌尿科学]