205例成人过敏性紫癜性肾炎的临床病理与预后分析

Presentations and outcome analysis of 205 adult patients with Henoch- Sch6nlein purpura nephritis

目的研究成人过敏性紫癜性肾炎（HSPN）的临床、病理特点及转归情况。方法收集本中心2004年1月至2013年5月期间确诊为HSPN并行肾穿刺活检的205例患者临床、病理及治疗后转归资料，根据不同条件分组进行回顾性分析。结果患者平均年龄（33±16）岁，病程中均有紫癜样皮疹，其中腹型51例（25％）、关节型38例（18．5％）。肾脏表现均有镜下血尿，尿蛋白总量≤1g／24h者67例（32．7％），1．0—3．5g／24h者93例（45．4％），〉t3．5g／24h者45例（21．9％）。肾小球滤过率（eGFR）≥90ml·min-1·（1．73m2）。者151例（73．7％），61～89ml·min-1·f1．73m2）。者29例（14．1％），≤60ml·min-1·（1．73my者25例（12．2％）。肾脏病理分级中Ⅱ级42例（20．5％），Ⅲ级147例（71．7％），Ⅳ级15例（7．3％），V级1例（0．5％）。按年龄分组比较，年龄≤18岁患者合并腹型较多（42％）；年龄≥50岁患者血沉、c反应蛋白、IgA水平较高，eGFR水平较低，肾小球硬化比例较高。失访患者38例（18．5％），余167例中位随访时间15个月，其中完全缓解124例（60．5％），部分缓解15例（7．3％），未缓解22例（10．7％），终末期肾病6例（2．9％）。以未缓解与终末期肾病定义为治疗失败进行Cox回归分析发现年龄是治疗失败的独立危险因素（OR=2．434，P=O．011）。结论老年HSPN患者疾病活动度较高，肾功能下降较明显，治疗失败风险较高。

Objective To analyze the clinical, pathological data and outcomes of the adult patients with Henoch-Scht^nlein purpura nephritis （HSPN）. Methods The data of 205 HSPN patients who were diagnosed in Kidney Disease Center of the First Affiliated Hospital of Zhejiang University between Jan 2004 and May 2013 were collected and analyzed in different groups. Results The average age of the patients was （33 ± 16） years old. All patients had purpura, 25% patients had abdominal symptoms and arthritis was reported in 18.5% patients. All patients reported hematuria; 32.7% patients were with urine protein less than 1 g/24 h and 21.9% patients had urine protein more than 3.5 g/24 h; 73.7% patients had normal level of glomerular filtration rate （eGFR, calculated by simplified MDRD equation）; 14.1% patients had mild renal insufficiency [eGFR 60 - 90 ml. min-1 （1.73 m2）-x] and 12.2% patients were with eGFR less than 60 ml. rain-1 （1.73 m2）-1. The type I1 renal pathological changes were reported in 20.5% patients, 71.7% patients were with type 111, 7.3% patients were with type IV and only one patient had type V pathologieal changes. The patients younger than 18 years had more abdominal involvement; the patients older than 50 years had higher levels of ESR, serum C reactive protein, serum IgA and more proportion of glomerular sclerosis, but lower eGFR level. Thirty-eight patients （18.5%） were lost follow up. The median follow-up of the other 167 patients was 15 months. The complete remission was reported in 124 patients （60.5%） and partial remission were reported in 15 patients （7.3%）; 22 cases were unrelieved and 6 cases exhibited end stage renal disease （ESRD）. The COX regression analysis revealed that old age was the independent risk factor of no relief and ESRD （P=0.011, OR= 2.434）. Conclusion The elderly HSPN patients has higher disease activity, more obvious decline in renal function and higher risk of treatment failure.