特发性膜性肾病患者免疫抑制剂治疗效果的影响因素

Related factors of the immune inhibitor treatment outcomes in patients with idiopathic membranous nephropathy

目的分析影响免疫抑制剂治疗特发性膜性肾病(IMN)患者效果的相关因素,为临床治疗提供指导。方法回顾性分析府谷县人民医院及西安交通大学第二附属医院2010年1月至2011年9月确诊的149例IMN患者的临床资料,所有患者均接受免疫抑制剂治疗,随访12~60个月,以末次随访疗效分为两组,完全或部分缓解的126例为有效组,未达缓解、肾功能恶化或进展至终末期肾衰(ESRF)、死亡的23例患者为无效组,采用多因素非条件Logistic回归分析影响预后的相关因素。结果无效组患者病理分期Ⅲ~Ⅳ期、高血压、镜下血尿构成比例分别为39.13%、47.83%、56.52%,明显高于有效组的16.67%、15.87%、20.63%,差异均有统计学意义(P<0.05);无效组患者治疗前、6个月、12个月、24个月尿蛋白水平和Scr水平均高于有效组,差异均有统计学意义(P<0.05);Logistic回归分析结果显示,镜下血尿、持续高尿蛋白、高血压、高Scr是影响IMN患者免疫抑制剂治疗预后的主要因素(P<0.05)。结论患者合并高血压,镜下血尿,持续高尿蛋白及高Scr是影响IMN患者免疫抑制剂治疗预后的主要因素,治疗期间应给予合理的干预,提高疗效和预后。

Objective To analyze the related factors of the immune inhibitor treatment outcomes in patients with idiopathic membranous nephropathy（IMN）, and provide guidance for clinical intervention. Methods The clinical data of 149 patients with IMN who confirmed in the People＇s Hospital of Fugu County and the Second Affiliated Hospital of Xi＇an Jiaotong University from January 2010 to September 2011 were retrospectively analyzed. All patients were treated with immunosuppressive agents, which were followed up for 12 to 60 months. All patients were divided into two groups according to the last follow-up treatment efficacy： complete or partial response as effective group（n=126）, no reached remission, deterioration of renal function or progression to end-stage renal failure（ESRF）, and death as invalid group（n=23）. Multivariate non-conditional logistic regression was used to analyze the related factors affecting prognosis. Results The composition proportion of pathological stage Ⅲ-Ⅳ, hypertension, microscopic haematuria in invalid group were respectively 39.13%, 47.83%, 56.52%, which were significantly higher than 16.67%, 15.87%,20.63% of the effective group, P0.05. The urinary protein levels and Scr levels of invalid groups before treatment, 6months, 12 months and 24 months after treatment were significantly higher than those of effective group, P0.05. Logistic regression analysis showed that microscopic haematuria, persistent high proteinuria, hypertensio, and high Scr were the main factors affecting the immunosuppressant therapy on IMN patients＇ prognosis. Conclusion Hypertension, microscopic haematuria, persistent high proteinuria protein and high Scr are the main factors affecting the immunosuppressant treatment outcomes for patients with IMN, and the treatment period should be given reasonable intervention to improve the efficacy and prognosis.