慢性肾小球肾炎治疗总有效率及失效的危险因素分析

Risk factors of treatment failure in patients with chronic glomerulonephritis

目的 探讨慢性肾小球肾炎治疗的总有效率及失效的危险因素.方法 回顾性分析2007年1月1日至2012年12月31日257例慢性肾小球肾炎患者,所有患者给予控制血压、降低尿蛋白等常规治疗,同时根据年龄分成青年组（＜65岁）及老年组（≥65岁）并探讨其治疗的总有效率.用Logistic回归探讨治疗失败的危险因素.结果 在257例慢性肾小球肾炎患者中,164例缓解,总有效率63.8％,共93例无效,无效率为36.2％.相对于青年组,老年组有更低的治疗总有效率（51.8％ vs.67.2％,P＜0.001）.校正其它混杂因素后,治疗前的高龄（每增加10年,优势比（OR）1.27,95％可信区间[（CI）1.11-1.98,P=0.002]、高血压病史（OR 2.41,95％CI 1.15～3.24,P=0.021）、膜增生性肾小球肾炎（OR 1.38,95％ CI 1.23～ 2.96,P=0.031）、膜性肾病（OR 1.64,95％CI 1.20～3.57,P=0.019）及较大的尿蛋白量（OR 1.23,95％CI 1.12～ 1.77,P=0.001）是总体人群治疗无效的独立危险因素.结论 老年慢性肾小球肾炎治疗总有效率要比青年患者低;治疗前高龄、高血压病史、糖尿病病史及较大的尿蛋白量是慢性肾小球肾炎患者治疗无效的独立危险因素.

Objectives Studies on risk factors of treatment failure in patients with chronic glomerulonephritis had received little attention.Methods 257 patients with chronic glomerulonephritis were included from February 1 2007 to December 31 2011.Conventional therapies were conducted in these patients such as control of blood pressure.All patients were divided into two groups （the youth group ＜ 65 years and the old group ≥65 years）.We performed Logistic regression to evaluate risk factors of treatment failure in all patients.Results 93 （36.2％） occurred treatment failure in 257 patients with chronic glomerulonephritis.Treatment failure in the old group was significantly higher as compared to the youth group （51.8％ vs.67.2％,P ＜0.001）.Age （increased 10 years OR1.27,95％ CI1.11 ～ 1.98,P =0.002）,hypertension （OR 2.41,95％ CI 1.15 ～ 3.24,P =0.021）,membranoproliferative glomerulonephritis （OR 1.38,95 ％ CI 1.23 ～ 2.96,P =0.031）,membranous nephropathy （OR 1.64,95％ CI 1.20 ～ 3.57,P =0.019） and higher proteinuria （OR 1.23,95％ CI 1.12 ～ 1.77,P =0.001） were independently risk factors of treatment failure in all patients.Conclusions Older patients with chronic glomerulonephritis may have higher treatment failure,when compared with these younger patients.Older age,hypertension,membranoproliferative glomerulonephritis,membranous nephropathy and higher value of proteinuria were independently risk factors of treatment failure in all patients.