文章摘要

IgA肾病合并肾病综合征的危险因素

作者: 1咸素贞, 1刘杨, 1王明奡, 1刘晓刚, 1邢丽, 1马静, 1隋满姝
1 哈尔滨医科大学附属第一医院肾内科,哈尔滨 150001
通讯: 隋满姝 Email: suimanshu@163.com
DOI: 10.3978/j.issn.2095-6959.2020.12.008

摘要

目的:探讨IgA肾病(IgA nephropathy,IgAN)合并肾病综合征(nephrotic syndrome,NS)患者的预后及其相关危险因素。方法:收集2012年1月至2017年12月哈尔滨医科大学附属第一医院肾内科住院的所有经肾活检确诊为IgAN的214名患者的一般临床病理及实验室检查结果,按照是否合并NS将IgAN患者分为NS组和非NS组,比较两组患者一般临床病理资料和实验室检查指标,并进一步探讨以NS为临床表现的IgAN患者的临床病理特征,分析影响其预后的危险因素。结果:NS组84例,非NS组130例。两组间肾活检时平均动脉压(mean arterial pressure,MAP)、尿红细胞计数、血肌酐(serum creatinine,SCr)、血尿素氮(blood urea nitrogen,BUN)、血尿酸(uric acid,UA)、胱抑素C (cystatin C,CysC)、总胆固醇(cholesterol,CHOL)、三酰甘油(triglyceride,TG)和估计的肾小球滤过率(estimated glomerular filtration rate,eGFR)差异均有统计学意义(均P<0.05)。NS组肾小球毛细血管内皮细胞增生(E1)、细胞/纤维细胞性新月体(C1~2)、MESTC评分≥3及eGFR<60 mL/min等发生率均明显高于非NS组(均P<0.05)。随访结束时,NS组24 h尿蛋白定量明显高于非NS组,eGFR水平明显低于非NS组(均P<0.05),eGFR水平与肾活检时的年龄,MAP,BUN,SCr,CysC,UA,牛津分型S和T有显著相关性(均P<0.05)。结论:IgAN合并NS患者eGFR的降低与肾活检时年龄,MAP,BUN,SCr,UA,S1和T1~2有显著相关性。
关键词: IgA肾病;肾病综合征;牛津分型;估计的肾小球滤过率

Risk factors of IgA nephropathy patients with nephrotic syndrome

Authors: 1XIAN Suzhen, 1LIU Yang, 1WANG Mingao, 1LIU Xiaogang, 1XING Li, 1MA Jing, 1SUI Manshu
1 Department of Nephrology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China

CorrespondingAuthor: SUI Manshu Email: suimanshu@163.com

Abstract

Objective: To investigate the risk factors of IgA nephropathy (IgAN) patients with nephrotic syndrome (NS). Methods: A total of 214 patients of IgAN diagnosed by renal biopsy from January 2012 to December 2017 were retrospectively analyzed. According to whether manifesting as NS in clinic, the patients were divided into NS group and non-NS group. The clinical and pathological characteristics in the two groups were analyzed. Then the clinical, pathological features and outcomes of IgAN with NS as the clinical manifestations were further analyzed. Linear correlation analysis was used to analyze the risk factors related to its prognosis. Results: There were 214 IgAN patients in our study, including 84 patients with NS and 130 patients without NS. There were statistical differences in mean arterial pressure (MAP), hematuria, serum creatinine (SCr), blood urea nitrogen (BUN), blood uric acid (UA), cystatin C (CysC), cholesterol (CHOL), triglyceride (TG) and estimated glomerular filtration rate (eGFR) between the two groups (all P<0.05). The IgAN patients with NS had higher proportion of endocapillary hypercellularity (E1) and cellular or fibrocellular crescents (C1–2) in renal pathology. Furthermore, the proportion of the MESTC scores ≥3, eGFR <60 mL/min at the time of renal biopsy was significantly higher (all P<0.05). In addition, the proteinuria was significantly higher and eGFR was significantly lower at the end of follow-up in the NS group than in the non-NS group (all P<0.05), and the eGFR at the end of follow-up had a significant correlation to the age, MAP, BUN, SCr, CysC, UA, Oxford Classification S and T at the time of renal biopsy in NS group (all P<0.05). Conclusion: The eGFR at the end of follow-up had a significant correlation to the age, MAP, BUN, SCr, UA, S1 and T1–2 at the time of renal biopsy in NS patient.
Keywords: IgA nephropathy; nephrotic syndrome; Oxford Classification; estimated glomerular filtration rate