重症抗中性粒细胞胞浆抗体相关性肾炎患者行肾脏替代疗法治疗后不良预后危险因素分析

Analysis of independent risk factors for adverse prognosis in patients with severe AAGN after renal replacement therapy

目的探讨重症抗中性粒细胞胞浆抗体相关性肾炎(AAGN)患者行肾脏替代疗法(RRT)治疗后不良预后独立危险因素,为临床治疗方案选择及预后评价积累更多循证医学证据。方法回顾性分析行RRT治疗重症AAGN患者共56例临床资料,根据治疗3个月是否摆脱RRT分组,其中23例摆脱设为A组,33例未摆脱设为B组;比较两组患者基线临床病理特征和治疗方案,并分析未摆脱RRT、全因死亡及治疗相关死亡影响因素。结果A组患者正常肾小球和肾小管间质急性病变比例均显著高于B组(P<0.05);但A组球性硬化和肾小管间质慢性病变比例均显著低于B组(P<0.05);A组患者行强化免疫和IA/DFPP治疗比例均显著高于B组(P<0.05);其中A组行MMF治疗比例显著高于B组(P<0.05);logistic回归模型多因素分析提示,正常肾小球比例<8%、球性硬化比例≥50%及未行强化免疫治疗是导致AAGN患者未摆脱RRT的高危因素(P<0.05);Cox回归模型多因素分析显示肺出血和白蛋白水平<30 g/L是全因死亡独立危险因素(P<0.05);而白蛋白水平<30 g/L和行IA/DFPP治疗是治疗相关死亡独立危险因素(P<0.05)。结论重症AAGN患者能否摆脱RRT与正常肾小球比例、球性硬化比例及接受强化免疫治疗是密切相关;而行IA/DFPP治疗和白蛋白水平<30 g/L则是重症AAGN患者治疗相关死亡独立危险因素。

Objective To investigate the independent risk factors for adverse prognosis in patients with severe AAGN after renal replacement therapy(RRT).Methods Clinical data of 56 patients with severe AAGN after RRT were retrospectively selected,and divided into Group A(23 cases),with RRT after 3 months,and Group B group(33 cases),without RRT after 3 months.The baseline clinicopathological features and treatment schemes of the 2 groups were compared,and the influencing factors on RRT dispensed,all-cause death and treatment-related death were analyzed.Results The normal glomerular proportion and tubulointerstitial acute lesions proportion of Group A were significant higher than Group B(P<0.05).The glomerulosclerosis proportion and chronic tubulointerstitial lesions proportion of Group A were significant lower than Group B(P<0.05).The proportion of intensive immunization and IA/DFPP of Group A were significant higher than Group B(P<0.05).The proportion of MMF of Group A was significant higher than Group B(P<0.05).Logistic regression model multivariate analysis showed that the normal glomerular ratio<8%,glomerular sclerosis ratio>50%and no intensive immunotherapy were the high risk factors leading to AAGN patients with RRT(P<0.05).Cox regression model multivariate analysis showed that pulmonary hemorrhage and albumin levels<30 g/L were independent risk factors for all-cause mortality(P<0.05).Cox regression model multivariate analysis showed that Albumin level<30 g/L and IA/DFPP treatment were independent risk factors for treatment-related death(P<0.05).Conclusion Whether severe AAGN patients can get rid of RRT is closely correlated to normal glomerular ratio,glomerular sclerosis ratio and intensive immunotherapy,while IA/DFPP treatment and albumin level<30 g/L are independent risk factors for treatment-related death of severe AAGN patients.