成人型多囊肾病149例肾功能危险因素分析

Analysis on aggravating factors in renal function of 149 patients with autosomal dominant polycystic kidney disease

目的探讨常染色体显性遗传性多囊肾病(ADPKD)患者临床特点及导致肾功能损害进展加速的因素。方法回顾性分析149例ADPKD患者临床资料,按照年龄、病程、血压、血尿程度、血脂情况、肾脏体积、24小时尿蛋白定量、是否合并泌尿系结石、有无家族史进行分组,分析上述因素对肾功能损害进展的影响。结果血尿、高血压、蛋白尿、肾功能异常、合并多囊肝是本病最常见的临床表现。病程年限越长(≥5年)、血压越高(≥160/100 mmHg)、肾脏体积越大(≥300 cm×300 cm×300 cm),肾功能损害越重(P<0.05);伴有血尿、蛋白尿、高脂血症者肾功能损害较无上述症状者更严重(P<0.05)。结论 ADPKD患者肾功能恶化与年龄、家族史无明显关系,但与病程延长、血压增高、蛋白尿、脂质代谢紊乱、血尿、肾脏体积大小密切相关,临床上应早期发现、积极治疗上述因素,尽量延缓多囊肾肾功能恶化的进程。

Objective To analyze clinical characteristics and factors which accelerate the progress of renal dysfunction in patients with autosomal dominant polycystic kidney disease（ADPKD）.Methods The clinical data including various complications in 149 patients with ADPKD were retrospectively analyzed.All patients were divided into different groups according to age,disease duration,blood pressure,hematuria level,blood lipid,renal volume,24-hour urine protein,the urinary stones and family history.We analyzed the relationship between the above-mentioned factors with the renal function.Results Hematuria,hypertension,proteinuria,renal dysfunction,the merged polycystic liver disease were the most common clinical manifestations.The longer the duration of disease,the higher blood pressure;the greater kidney volume,the more severe renal dysfunction（P〈0.05）.The renal dysfunction was heavier in patients accompanied by hematuria,proteinuria or hyperlipidemia than in the non-above mentioned symptoms subjects（P〈0.05）.Conclusion There is no significant relationship between renal function with age,family history,but the blood pressure,proteinuria,disease duration,lipid metabolism disorder,hematuria,kidney volume size are closely related to renal function.We should detect and treat these factors earlier in order to slow down the process of renal function deterioration in polycystic kidney disease.