增生硬化性IgA肾病伴贫血患者的临床病理特征及预后研究

Clinicopathological Features and Prognosis in Patients with Proliferative and Sclerosing IgA Nephropathy with Anemia

目的分析增生硬化性IgA肾病(IgAN)伴贫血患者的临床病理特征及预后。方法选取2012年1月—2016年6月在郑州大学第一附属医院行肾脏穿刺活检诊断为增生硬化性IgAN的患者261例为研究对象。按照贫血的诊断标准,将患者分为贫血组(100例)和非贫血组(161例)。收集患者一般资料、实验室检查结果、肾组织病理检查指标,以肾活检日期为起点,随访至2017-06-01。采用Kaplan-Meier法绘制生存曲线,进行Log-rank检验;采用多因素Cox比例风险模型分析贫血对增生硬化性IgAN患者预后的影响。结果贫血组患者估算肾小球滤过率(e GFR)、清蛋白、血钙低于非贫血组,尿素、血肌酐、血磷、24 h尿蛋白定量、肾小球总硬化比例、肾小管萎缩/间质纤维化≥25%发生率高于非贫血组(P<0.05)。中位随访时间为11(6,21)个月,两组患者生存曲线比较,贫血组患者肾脏累积生存率低于非贫血组(χ~2=30.307,P<0.001)。CKD3期不同贫血程度患者肾脏累积生存率比较,差异有统计学意义(χ~2=22.066,P<0.001)。多因素Cox比例风险模型分析显示,贫血[HR=2.864,95%CI(1.611,5.093)]、24 h尿蛋白定量[HR=1.164,95%CI(1.065,1.272)]、肾小球总硬化比例[HR=3.858,95%CI(1.120,13.290)]、肾小管萎缩/间质纤维化[HR=1.902,95%CI(1.070,3.383)]是增生硬化性IgAN进展至终末期肾脏病(ESRD)的危险因素(P<0.05)。结论增生硬化性IgAN伴贫血患者的临床病理表现相对较严重,肾脏累积生存率较低,且贫血是增生硬化性IgAN病情进展的独立危险因素。

Objective To analyze the clinicopathological features and prognosis in patients with proliferative and sclerosing IgA nephropathy with anemia.Methods 261 cases of proliferative and sclerosing IgA nephropathy diagnosed by renal biopsy were recruited from the First Affiliated Hospital of Zhengzhou University between January 2012 and June 2016 and divided into anemia group（100 cases with anemia） and non-anemia group（161 cases without anemia）（anemia was determined by the corresponding diagnostic criteria）.The demographic data,laboratory findings,histopathological examination results of renal biopsies were collected.All of them were followed up from the date of renal biopsy to June 1,2017.Kaplan-Meier method was used to draw the survival curve.Log-rank test and multivariate Cox proportional hazards regression model were adopted to explore the value of anemia in predicting the prognosis of patients.Results Compared with non-anemia group,anemia group had much lower initial e GFR,serum albumin and calcium levels but higher urea,serum creatinine,phosphorus,24 h urine total protein（UTP） and percentage of glomeruli affected by sclerosis,as well as higher tubular atrophy and interstitial fibrosis levels（P〈0.05）.The patients had a median follow-up time as 11（6,21）months.Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without（χ~2=30.307,P〈0.001）.Survival analyses statistically significant difference in the cumulative renal survival rate among patients with CKD3（χ~2=22.066,P〈0.001）.Multivariate Cox hazards regression analysis revealed that anemia[HR=2.864,95%CI（1.611,5.093）],24 h UTP[HR=1.164,95%CI（1.065,1.272）],percentage of glomeruli affected by sclerosis[HR=3.858,95%CI（1.120,13.290）],tubular atrophy and interstitial fibrosis[HR=1.902,95%CI（1.070,3.383）] were risk factors for proliferative and sclerosing IgA nephropathy developing into end-stage renal disease（P〈0.05）.Conclusion Proliferative and sclerosing IgA nephropathy with anemia patients with anemia showed worse clinicopathological features and lower cumulative renal survival rate compared with those without.Anemia was an independent risk factor for the development of proliferative and sclerosing IgA nephropathy.