慢性肾功能不全IgA肾病患者资料分析

Data analysis of chronic renal insufficiency patients with IgA nephropathy

目的探讨个体化、低剂量、联合免疫抑制剂治疗方案对慢性肾功能不全免疫球蛋白A(IgA)肾病的治疗效果。方法收集62例接受个体化免疫抑制剂治疗的慢性肾功能不全IgA肾病患者的临床和病理资料,分析其治疗效果,比较不同疗效组患者的临床指标和病理参数。结果 2013～2015年本院有慢性肾功能不全的IgA肾病患者78例,其中62例患者均接受个体化、低剂量、联合免疫抑制剂方案治疗。随访≥12个月后,完全缓解18例,部分缓解34例,未缓解10例,有效缓解率为83.87%。不同疗效患者的性别、年龄、血红蛋白(Hb)、尿酸(SUA)、甘油三酯(TG)水平比较,差异无统计学意义(P>0.05);未缓解患者的慢性肾脏病(CKD)5期、高血压、血清肌酐(Scr)、肾小球滤过率(eGFR)水平与完全缓解、部分缓解患者比较,差异有统计学意义(P<0.05);不同疗效患者的24 h尿蛋白定量(Upro)、血浆白蛋白(Alb)水平比较,差异有统计学意义(P<0.05)。不同疗效患者内皮细胞增殖(E)指标比较,差异无统计学意义(P>0.05);未缓解患者系膜细胞增生(M)、肾小管萎缩(T2)指标与完全缓解患者比较,差异有统计学意义(P<0.05);部分缓解患者节段硬化(S)、T0指标与完全缓解患者比较,差异有统计学意义(P<0.05);未缓解患者M、S、T2指标与部分缓解患者比较,差异有统计学意义(P<0.05)。结论联合免疫抑制剂治疗方案应用于慢性肾功能不全IgA肾病患者的治疗中,能在短期内有效缓解尿蛋白和稳定肾功能。治疗慢性肾功能不全IgA肾病患者的方案要依据其临床表现和肾脏病理改变来制定。

Objective To investigate the therapeutic effect of individualized, low-dose, combined immunosuppressive therapy on chronic renal insufficiency immunoglobulin A（IgA） nephropathy. Methods The clinical and pathological data of 62 patients with chronic renal insufficiency IgA nephropathy who received individualized immunosuppressive agents were collected, the therapeutic effects were analyzed. The clinical and pathological parameters of patients in different therapeutic groups were compared. Results From 2013 to 2015, there were 78 IgA nephropathy patients with chronic renal insufficiency in our hospital, among them, 62 patients received individualized, low-dose and combined immunosuppressive therapy. After a follow-up of more than or equal to 12 months, complete remission was achieved in 18 cases, partial remission in 34 cases, and no remission in 10 cases. The effective remission rate was 83.87%. There were no significant differences in the sex, age, hemoglobin（Hb）, serum uric acid（SUA） and triglyceride（TG） levels among patients with different therapeutic effects（P0.05）. The levels of chronic kidney disease（CKD） stage 5, hypertension, serum creatinine（Scr）, estimated glomerular filtration rate（eGFR） in patients without remission were significantly higher than those in complete remission and partial remission（P〉0.05）. The 24-hour urinary protein quantification（Upro） and plasma albumin（Alb） levels in patients with different therapeutic effects were significantly different（P〈0.05）. There was no significant difference in the endothelial cell proliferation（E） among patients with different therapeutic effects（P〈0.05）. The mesangial cell proliferation（M） and tubular atrophy（T2） index in patients without remission were significantly different from those in complete remission, the differences were statistically significant（P〉0.05）. The segmental sclerosis（S） and T0 index in patients with partial remission were significantly different from those with complete remission, the differences were statistically significant（P〈0.05）. There were significant differences in M, S and T2 index between patients without remission and those with partial remission（P〈0.05）. Conclusion Combined immunosuppressive therapy can effectively relieve urinary protein and stabilize renal function in chronic renal insufficiency patients with IgA nephropathy. The treatment of chronic renal insufficiency with IgA nephropathy should be based on clinical manifestations and renal pathological changes.