无高血压和糖尿病的特发性膜性肾病患者肾内动脉病变特点及其预后影响分析  

Analysis of characteristics of intrarenal arterial lesions and their effect on prognosis of idiopathic membranous nephropathy patients without hypertension and diabetes

作　　者：王琳娜 郭存霞[2] 乔东鸽[3] 赵旭[2] 阎磊[1] 邵凤民 陈香美 Wang Linna;Guo Cunxia;Qiao Dongge;Zhao Xu;Yan Lei;Shao Fengmin;Chen Xiangmei(Department of Nephrology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province;Department of Nephrology,Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou 45000,Henan Province;First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan Province;Department of Nephrology,First Medical Center of Chinese PLA General Hospital,National Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Bejing Key Laboratory of Kidney Diseases Research,Beijing 100853,China)

机构地区：[1]郑州大学人民医院河南省人民医院肾内科,450000 [2]河南省中医院肾病科,郑州450000 [3]河南中医药大学第一附属医院,郑州450000 [4]解放军总医院第一医学中心肾脏病医学部、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心、肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中华肾病研究电子杂志》2024年第1期39-45,共7页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：中国博士后科学基金面上项目(2015M582858);河南省基础与前沿研究计划(162300410243);河南省中医药科学研究专项课题(20-21ZY2050)。

摘　　要：目的:对不伴高血压和糖尿病的特发性膜性肾病(IMN)患者,分析其肾内动脉病变(AL)的病理特征及其预后影响。方法:回顾性分析2011年1月1日至2018年4月30日就诊于解放军总医院肾脏病科、经肾活检确诊为IMN、并且排除了高血压和糖尿病的患者资料,包括基本信息、实验室检查、肾脏病理和治疗方案等,并进行肾脏病理评分。采用Kaplan-Meier生存曲线法分析AL病变对患者预后的影响。应用Logistic回归和Cox回归模型分析IMN患者预后的危险因素。结果:共纳入1293例IMN患者,有AL病变的660例为AL(+)组,无AL病变的633例为AL(-)组。与AL(-)组比较,AL(+)组患者的年龄、收缩压、舒张压、血清肌酐水平均较高(P均<0.05),肾小球全球硬化、间质病变明显增多(P均<0.001)。中位随访时间8.0(4.0,18.0)个月,共有404例患者完成了随访,其中AL(+)组172例、AL(-)组232例。肾穿后第9个月、12个月及24个月时,AL(-)组患者的药物治疗完全缓解率均高于AL(+)组(P均<0.05)。126例患者有不同程度的药物治疗不良事件,其中AL(-)组明显少于AL(+)组(P=0.004)。15例患者的估算肾小球滤过率下降>25%,其中AL(-)组明显少于AL(+)组(P=0.003)。3例患者进展为终末期肾脏病,均在AL(+)组(χ^(2)=4.067、P=0.044)。多因素Cox回归模型分析表明,基线血清肌酐水平高(HR=1.032,95%CI:0.009~1.056,P=0.006)和AL病变(HR=8.786,95%CI:1.167~66.144,P=0.035)是发生肾功能恶化的独立危险因素。结论:具有肾内动脉病变的IMN患者,临床和病理表现较重、不良事件较多、肾脏预后较差。肾内动脉病变是IMN患者预后的独立危险因素。Objective To analyze the characteristics of intrarenal arterial lesions(AL)and their effect on prognosis of idiopathic membranous nephropathy(IMN)patients without hypertension and diabetes.Methods A retrospective analysis was performed on the data of patients,who had renal-biopsy-diagnosed IMN without hypertension and diabetes,in the Department of Nephrology,Chinese PLA General Hospital from January 1,2011 to April 30,2018,including basic information,laboratory examination,renal pathology,and treatment plan,while renal pathology scoring was also conducted.Kaplan-Meier survival curve method was used to analyze the impact of AL on prognosis of the IMN patients.Logistic regression and Cox regression models were applied to analyze the risk factors for prognosis of the IMN patients.Results A total of 1293 IMN patients were included,among whom 660 patients with AL were taken as the AL(+)group,while 633 patients without AL lesions as the AL(-)group.Compared with the AL(-)group,the AL(+)group had higher levels in age,systolic blood pressure,diastolic blood pressure,and serum creatinine(all P<0.05),with significant increases in global glomerulosclerosis and interstitial lesions(both P<0.001).A total of 404 patients completed a median follow-up of 8.0(4.0-18.0)months,including 172 cases in the AL(+)group and 232 cases in the AL(-)group.At 9,12,and 24 months after renal biopsy,the complete response rate of drugs treatment in the AL(-)group was higher than that of the AL(+)group(P<0.05).Adverse events of drugs treatment occurred in 126 patients,which were significantly fewer in the AL(-)group than in the AL(+)group(P=0.004).The eGFR decreased by more than 25%in 15 patients,among whom there were fewer patients from the AL(-)group than from the AL(+)group(P=0.003).Three patients progressed to ESRD,with all of whom in the AL(+)group(χ^(2)=4.067,P=0.044).Multivariate Cox regression analysis showed that the high baseline serum creatinine level(HR=1.032,95%CI:0.009-1.056,P=0.006)and AL(HR=8.786,95%CI:1.167-66.144,P=0.035)were ind

关 键 词：膜性肾病 动脉病变 临床病理特征 预后 

分 类 号：R692[医药卫生—泌尿科学]