IgA肾病在终末期肾病中的构成比分析

Analysis of constituent ratio of IgA nephropathy in end-stage renal disease

目的通过收集上海交通大学医学院附属仁济医院终末期肾病(ESRD)患者的临床数据,分析IgA肾病(IgAN)在上海交通大学医学院附属仁济医院ESRD中的构成比及其进展情况。方法收集231例在2015年12月—2016年12月间在上海交通大学医学院附属仁济医院诊断为慢性肾脏病5期患者的临床资料,包括一般人口学资料、既往疾病史、实验室和其他辅助检查资料。分析患者的年龄、性别、病因构成,以及IgAN、高血压肾病、糖尿病肾病和多囊肾4种ESRD常见类型患者的临床资料。结果年龄构成:231例患者年龄17～95岁,中位年龄为54岁,其中≤20岁仅1例(0.43%),21～40岁51例(22.08%),41～60岁84例(36.36%),61～75岁68例(29.44%),>75岁27例(11.69%)。主要病因及其年龄段构成:ESRD的前3位病因分别为慢性肾小球肾炎38例(16.45%)、高血压肾病23例(9.95%)和糖尿病肾病16例(6.92%);慢性肾小球肾炎患者以21～40岁和61～75岁常见,其中IgAN患者以21～40岁最为常见(占63.16%),而其他慢性肾小球肾炎患者以61～75岁最为常见;高血压肾病和糖尿病肾病患者均以41～60岁常见。不同年龄段患者的病因构成:21～40岁患者的病因以慢性肾小球肾炎最常见,其中尤以IgAN最为常见(占23.53%);41～60岁患者的主要病因是高血压肾病和糖尿病肾病,分别占11.90%、9.52%;61～75岁患者的病因以慢性肾小球肾炎、高血压肾病、糖尿病肾病为主,分别占14.71%、8.82%、7.35%;>75岁患者最常见的病因是高血压肾病,占22.22%。性别构成:231例患者中,男145例(62.77%)、女86例(37.23%),男女比例为1.69∶1;除≤20岁者为1例女性患者和>75岁的患者中女性多于男性外,21～75岁的患者中男性均多于女性。ESRD常见类型患者比较:IgAN、高血压肾病、糖尿病肾病和多囊肾患者间年龄的差异有统计学意义(F=7 183,P<0.001),其中IgAN患者的年龄最小(P<0.01)。IgAN、高血压肾病、糖尿病肾病和多囊肾患者发展到ESRD的中位病程分别为6、10、12、10年,4组间的病程(χ~2=12.694,P=0.005)、尿红细胞(χ~2=13.067,P=0.005)、尿蛋白(χ~2=12.415,P=0.007)、24 h蛋白尿(χ~2=13.209,P=0.003)、空腹血糖(χ~2=7.829,P=0.049)和糖化血红蛋白(χ~2=9.775,P=0.006)的差异均有统计学意义。IgAN患者的年龄显著小于其他类型慢性肾小球肾炎患者(P<0.05),而两者间病程、尿蛋白、尿红细胞、空腹血糖的差异均无统计学意义(P值均>0.05)。结论 IgAN是上海交通大学医学院附属仁济医院ESRD的主要病因之一。与高血压肾病、糖尿病肾病、多囊肾相比,IgAN进展至ESRD的时间更短、年龄更小。提高知晓率、早期诊断和治疗有助于降低ESRD的发病率。

Objective To analyze the constitution ratio and progression of IgA nephropathy(IgAN) in end-stage renal disease(ESRD) patients. Methods Clinical data of patients who were diagnosed as chronic kidney disease(CKD) stage 5 from December 2015 to December 2016 were collected, including general demographics, disease history, laboratory and other auxiliary examination. The age, gender, etiological composition, and clinical data of four common types of ESRD in patients with IgAN, hypertension nephropathy, diabetic nephropathy and polycystic kidney were analyzed. Results The age of 231 patients ranged from 17 to 95 years old, with a median age of 54 years;≤20 years old in one case(0.43%), 21-40 years old in 51 cases(22.08%), 41-60 years old in 84 cases(36.36%), 61-75 years old in 68 cases(29.44%) and over 75 years old in 27 cases(11.69%). The top three causes of ESRD were chronic glomerulonephritis in 38 cases(16.45%), hypertension in 23 cases(9.95%) and diabetic nephropathy in 16 cases(6.92%). Most chronic glomerular nephritis was found in patients aged 21-40 and 61-75 years old. Among these patients IgAN was more common between 21-40 years old(63.16%), whereas other types of chronic glomerular nephritis was more common with age between 61 and 75 years old. For both hypertension nephropathy and diabetic nephropathy, the common age was 41-60 years. Etiological composition of different age groups: chronic glomerulonephritis was the most common cause in patients aged 21-40 years old, especially IgAN(23.53%);hypertension nephropathy and diabetic nephropathy were the main causes in patients aged 41-60 years old, which accounted for 11.90% and 9.52%, respectively;chronic glomerulonephritis, hypertension nephropathy and diabetic nephropathy were the main causes in patients aged 61-75 years old, accounting for 14.71%, 8.82%, and 7.35%;in patients >75 years old, the most common etiology was hypertension nephropathy(22.22%). Gender composition: there were 145 males(62.77%) and 86 females(37.23%) with a ratio of 1.69 to 1. There were more males than females in patients aged 21 to 75 years. The patient aged ≤20 years old was a female and there were more women than men with age over 75 years old. Comparison of common types of ESRD patients: there was statistical difference in age among patients with IgAN, hypertensive nephropathy, diabetic nephropathy and polycystic kidney diseases(F=7 183, P<0.001), and the patients with IgAN were the youngest(P<0.01). The median disease courses of IgAN, hypertensive nephropathy, diabetic nephropathy and polycystic kidney disease advanced to ESRD were 6, 10, 12 and 10 years, respectively. There were significant differences in the disease course(χ^2=12.694, P=0.005), urine red blood cells(χ^2=13.067, P=0.005), proteinuria(χ^2=12.415, P=0.007), 24-hour proteinuria(χ^2=13.209, P=0.003), fasting blood glucose(χ^2=7.829, P=0.049) and glycosylated hemoglobin(χ^2=9.775, P=0.006) between patients with four types of ESRD. IgAN patients was significantly younger than other chronic glomerulonephritis patients(P<0.05). However, there were no significant differences in course of disease, proteinuria, urinary red blood cell or blood glucose between the two groups(all P<0.05). Conclusion IgAN is one of the main causes of ESRD in Renji Hospital of Shanghai Jiaotong University School of Medicine. Compared with hypertensive nephropathy, diabetic nephropathy and polycystic kidney, the progression duration to ESRD is shorter and patients are younger in IgAN. Increased awareness, early diagnosis and treatment may help to reduce the incidence of ESRD.