不同病理分期成人特发性膜性肾病患者免疫抑制治疗疗效及预后分析

Clinical Features and Prognostic Factors of Adult Patients with Idiopathic Membranous Nephropathy in Different Pathological Stage

目的:探讨经免疫抑制治疗后不同病理分期特发性膜性肾病(IMN)的近期疗效及预后分析。方法:回顾性分析本院2014年01月~2018年12月经肾活检确诊的具有完整临床及病理资料的91例IMN(Ⅰ~Ⅳ期)患者,均给予免疫抑制治疗,规律随访至少12个月,比较各期患者基线资料差异,通过生存分析评估各期患者肾病缓解及肾功能进展情况,用多因素COX回归筛选肾功能进展的影响因素。结果:Ⅳ期患者24 h尿蛋白定量少于与Ⅰ期和Ⅱ期患者,差异具有统计学意义(P <0.05);Kaplan-Meier生存分析表明,不同病理分期对IMN患者首次治疗应答(P> 0.05)无明显影响,但Ⅳ期的肾脏存活率低于Ⅰ期(P <0.05);多因素Cox回归模型显示,是否完全缓解对肾脏预后的影响具有统计学意义(P <0.05),但病理分期并非终末期肾病的独立预测因素(P> 0.05)。结论:免疫抑制治疗对不同病理分期IMN患者肾病缓解率并无差异;Ⅳ期患者容易出现肾脏损害,预后相对较差;积极治疗促进肾病缓解,可改善肾脏预后。

Objective: To analyze the curative effect and prognosis of patients with idiopathic membranous nephropathy(IMN) in different pathological stage after immunosuppressive therapy. Methods: Clinical and pathological data of 91 IMN patients(stageⅠ ~ Ⅳ),who were diagnosed in our hospital as IMN from January 2014 to December 2018,were retrospectively analyzed. Patients were treated with immunosuppressive agent and followed up for at least 12 months. The baseline data were compared. Remission rate and renal function decline were assessed by Kaplan-Meier analysis. COX regression was employed to analyze risks of IMN in developing to end-stage renal disease(ESRD). Results: Compared to stage Ⅰ patients,stage Ⅳ patients had lower quantity of 24-hour urinary protein(P < 0. 05). There were no significant difference of first complete remission between different pathological stage(P > 0. 05). Stage Ⅰ patients had better kidney function than stage Ⅳ patients(P < 0. 05). Multivariate analysis by COX regression showed that complete remission was protective factor in prognosis of IMN patients(P < 0. 05),but pathological stage was not(P <0. 05). Conclusion: There is no difference of remission rate between different pathological stage IMN patients with immunosuppressive therapy. Stage Ⅳ patients are more likely to have progression of kidney function and poor prognosis. Effective treatment can promote remission rate and improve outcome.