不同血清白蛋白水平的原发性膜性肾病患者预防性使用抗凝药物的临床预后分析  

Clinical Prognostic Analysis of Prophylactic Anticoagulant Use in Patients with Primary Membranous Nephropathy with Different Serum Albumin Levels

作　　者：胡安澜 董凯旋 陈曦[1] 周荣 于小勇 HU Anlan;DONG Kaixuan;CHEN Xi(Department of Nephrology,Shanxi Traditional Chinese Medicine Hospital,Xi’an,712046)

机构地区：[1]陕西中医药大学,西安712046 [2]陕西省中医医院,西安710003

出　　处：《中国中西医结合肾病杂志》2024年第4期314-318,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然科学基金资助项目(No.82174366);陕西省中医药管理局项目(No.2021-GJ-LC022)。

摘　　要：目的:探讨不同白蛋白水平的原发性膜性肾病患者在预防性使用抗凝药物后临床预后是否存在差异,为原发性膜性肾病预防性使用抗凝药物提供参考。方法:回顾性纳入陕西省中医医院肾病二科2015年1月1日—2021年12月31日经肾活检穿刺诊断为原发性膜性肾病(primary membranous nephropathy,PMN)患者的临床及病理资料,包括一般情况、临床资料、实验室检查指标等。筛选符合研究标准98例患者,根据不同血清白蛋白水平分为低白蛋白组(L1组,血清白蛋白<25 g/L),中白蛋白组(M1组,血清白蛋白25~32 g/L),高白蛋白组(H1组,血清白蛋白>32 g/L)。中位随访时间63个月,对预防性使用抗凝药物的三组患者的基线资料、临床结局以及影响临床结局的预测因素进行统计学分析。结果:共纳入符合研究标准98例患者,L1组42例,M1组31例,H1组25例,其中L1、M1、H1组分别有4例(9.5%)、9例(29.05%)、11例(44.05%)达到完全缓解,有25例(59.5%)、23例(74.2%)、20例(80.0%)达到部分缓解,有21例(50.0%)、17例(54.8%)、21例(84.0%)达到血尿缓解。三组在完全缓解及部分缓解差异具有统计学意义(P<0.05)。经log-rank检验发现,三组患者在完全缓解累积缓解率(P=0.008)、血尿缓解累积率(P=0.008)差异具有统计学意义,在部分缓解累积缓解率(P=0.276)差异无统计学意义。经多变量Cox回归分析,白蛋白水平与PMN患者的完全缓解呈正相关(95%CI 1.579~18.882,P<0.05)。结论:在预防性使用抗凝药物的原发性膜性肾病患者中不同水平的血清白蛋白临床结局具有差异性,对于预防性使用抗凝的原发性膜性肾病患者不同水平的血清白蛋白是影响临床结局的独立预测因素。Objective:To investigate whether there is a difference in clinical prognosis after prophylactic use of anticoagulants in patients with primary membranous nephropathy with different albumin levels,and to provide a reference for the prophylactic use of anticoagulants in primary membranous nephropathy.Methods:The clinical and pathological data of patients with primary membranous nephropathy(PMN)diagnosed by renal biopsy puncture from 1 January 2015 to 31 December 2021 in the Department of Nephrology,Shaanxi Provincial Hospital of Traditional Chinese Medicine were retrospectively included,including general information,clinical data,laboratory test indexes,etc.Ninety-eight patients who qualified for the study were evaluated and divided into low albumin group(L1 group,serum albumin<25 g/L),medium albumin group(M1 group,serum albumin 25~32 g/L),and high albumin group(H1 group,serum albumin>32 g/L)according to different serum albumin levels.With a median follow-up of 63 months,baseline information,clinical outcomes,and predictors of clinical outcomes were statistically analyzed for the three groups of patients on prophylactic anticoagulation.Results:A total of 98 patients meeting the study criteria were enrolled,42 in the L1 group,31 in the M1 group,and 25 in the H1 group,of which 4(9.5%),9(29.05%),and 11(44.05%)in the L1,M1,and H1 groups,respectively,achieved complete remission,25(59.5%),23(74.2%),and 20(80.0%)achieved partial remission,and 21(50.0%),17(54.8%),and 21(84.0%)achieved hematuria remission.The difference between the three groups in complete and partial remission was statistically significant(P<0.05).After log-rank test,it was found that the differences between the three groups were statistically significant in the cumulative remission rate of complete remission(P=0.008)and the cumulative rate of hematuria remission(P=0.008),and the difference was not statistically significant in the cumulative remission rate of partial remission(P=0.276).On multivariate Cox regression analysis,albumin level was positively as

关 键 词：原发性膜性肾病 抗凝药物 血清白蛋白 临床结局 

分 类 号：R692[医药卫生—泌尿科学]