大新月体比例对IgA肾病患者预后判断的价值

The value of large crescent in prognosis of patients with IgA nephropathy

目的:探究大新月体对IgA肾病(IgAN)患者预后的预测价值。方法:回顾性分析2008年1月至2017年2月在温州医科大学附属第一医院住院并经肾活检确诊为IgAN且包含至少1个大新月体(细胞性或纤维细胞性)的患者132例。按含大新月体的肾小球占肾小球总数的比例将患者分为2组,对照组:大新月体比例<15%,共100例,观察组:大新月体比例≥15%,共32例。比较2组间的临床表现和转归,采用Cox比例风险模型分析致肾脏复合终点事件(血肌酐较基础值翻倍或进入终末期肾病)的相关危险因素。结果:132例IgAN患者的大新月体比例为8.33%(5.00%,14.09%),中位随访时间为22(12,38)个月。与对照组比,试验组的年龄较大,平均动脉压水平较高,细胞毒类药物的使用率较高,RAS抑制剂的使用率较低,差异均有统计学意义(P均<0.05);与对照组比,试验组的尿蛋白和血清肌酐的水平均较高,大新月体比例及中重度肾小管间质病变的比例均较高,差异均有统计学意义(P均<0.01)。对照组和试验组肾脏复合终点事件的发生率分别为3%(3/100)和22%(7/32),组间差异有统计学意义(log rank χ~2=21.474,P<0.001)。多因素逐步Cox回归分析结果显示大新月体比例≥15%是肾脏生存结局的独立影响因素(HR=8.133,95%CI=1.220~54.219,P<0.05)。结论:含大新月体肾小球的比例≥15%可能与IgAN患者的不良肾脏预后有关。

Objective： To assess the value of large crescent in the prognosis of IgA nephropathy（IgAN）.Methods： A retrospective analysis of 132 patients admitted into the First Affiliated Hospital of Wenzhou Medical University from January 2008 to February 2017 who were diagnosed by renal biopsy as primary IgAN and contained at least 1 crescents（the crescent volume accounting for more than 50% of the Bowman＇s capsule, the same below） was performed. According to the proportion of glomerular crescents in the total number of glomeruli,the subjects were divided into control group with crescent proportion less than 15% and trial group with crescent proportion higher than 15%. The prognosis of the two groups was compared. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of renal end point event（Scr doubled compared to the baseline values or had end-stage renal disease）. Results： In 132 patients with IgAN, the median large crescent ratio was 8.33%（5.00%, 14.09%）. The median follow-up time was 22（12, 38） months. Compared with the control group, the average age of the patients in the trial group was older, and the level of mean arterial pressure was higher（P〈0.05）; the level of urinary protein and serum creatinine were higher（P〈0.01）; the ratio of large crescent and over moderate tubulo-interstitial lesion was higher（P〈0.01）. Compared with the control group, the usage rate of cytotoxic drugs in the trial group was higher, while the usage rate of RAS inhibitors was lower（P〈0.05）. Altogether 10 cases entered into end point events, of which 3 out of 100 were in control group,and 7 out of 32 in trail group. There was statistical differences in the incidence of end point events between the two groups（log rank χ2=21.474, P〈0.001）. Multiple factor stepwise Cox regression analysis results showed that the proportion of large crescents higher than 15% was an independent factor affecting the renal survival（HR=8.133, 95%CI=1.220-54.219, P〈0.05）. Conclusion： Large crescentic glomerular ratio above 15% may be related with negative renal outcomes of the patients with IgAN.