慢性肾小球肾炎患者恶性高血压的临床特点和预后  

Clinical features and prognostic factors of chronic glomerulonephritis with malignant hypertension

作　　者：程叙扬[1] 赵明辉[1] 李晓玫[1] 刘玉春[1] 

机构地区：[1]北京大学第一医院肾内科北京大学肾脏病研究所,100034

出　　处：《中华肾脏病杂志》2004年第2期79-82,共4页Chinese Journal of Nephrology

摘　　要：目的了解慢性肾小球肾炎患者出现的恶性高血压(MHT)的临床特点及其对肾脏疾病预后的影响。方法分析我科1990～2002年4月收治的肾脏病伴发MHT患者的临床和病理资料。用多元回归进行预后相关因素分析。结果符合诊断的共38例,男女比例3.75∶1;平均年龄(29.5±7.7)岁,皆为慢性肾小球肾炎患者,病因以IgA肾病最多见。这组患者的高血压知晓率75.7%,长期治疗率13.5%,控制率5.4%。其中6例发生急性肾衰竭,16例发生慢性肾衰竭基础上的急性肾衰竭,13例为慢性肾衰竭,3例肾功能正常。经过积极抗高血压治疗后,41.7%患者肾功能好转,需透析者中20%脱离透析。1年肾存活率55%。高血压家族史、最高收缩压(SBP)和舒张压(DBP)水平以及肾脏慢性病变积分是影响短期肾功能好转的不良指标。最高血肌酐水平和肾脏慢性病变积分是决定1年肾脏存活的重要指标。结论在年轻肾小球肾炎患者中发生MHT并不少见,严重影响肾脏预后。经过积极降压治疗部分患者可好转。最高血肌酐水平和肾脏慢性病变积分是决定1年肾脏存活的重要指标。肾性高血压治疗率和血压控制率低可能是这组患者容易发生MHT并导致肾功能快速恶化的重要原因。Objective To find out the clinical characteristics and prognostic risk factors of malignant hypertension (MHT) with pre existed chronic glomerulonephritis.Method The clinical and renal pathological data of 38 chronic glomerulonephritis patients with MHT hospitalized in our department from 1990 to 2002,and the associated factors for renal prognosis were analyzed. Results All the patients suffered from chronic glomerulonephritis.The ratio of male to female was 3 75∶1.The average age was (29 5±7 74)years old. The rates of recognition, therapy and control of hypertension before MHT onset were 75 7%, 13 5%and 5 4%respectively. IgA nephropathy was the most common pathological type.Of 38 cases,3 maintained normal renal function, 6 presented acute renal failure,13 presented chronic renal failure, and 16 had acute attack based on chronic renal failure. Twenty four patients were followed up for 1～6 months after antihypertensive therapy and renal function of 10(41 7%) was improved. 1 year renal survival rate of 20 patients was 55%. The analysis of risk factors showed that those patients who were possessed of positive hypertension family history(P=0 03), high SBP/DBP levels(P=0 023,0 047), and high scores of chronic index of renal pathology(P=0 032) had worse prognosis. The level of highest serum creatinine and the scores of chronic index of renal pathology were associated with 1 year renal survival(P=0 031,0 037).Conclusions MHT occuring in young patients with chronic glomerulonephritis is not rare, which becomes an important reason inducing rapidly decrease of renal function, especially in patients with IgA nephropathy. Actively antihypertensive therapy is helpful for renal function recovery. The low rates of recognition, therapy and control of pre existed renal hypertension may play key roles in the development of MHT. It is important to recognize and treat the hypertension at early stage of renal disease to improve the renal survival.

关 键 词：慢性肾小球肾炎 恶性高血压 降压治疗 MHT 肾功能衰竭 

分 类 号：R692.3[医药卫生—泌尿科学]