伴高血压的特发性膜性肾病临床病理特点及预后分析

Comparison of Prognostic Clinicopathological Features of Idiopathic Membranous Nephropathy with or Without Hypertension

目的:探讨伴或不伴高血压的特发性膜性肾病(IMN)临床病理特点及预后。方法:回顾性分析深圳市第二人民医院,2008年1月—2019年9月,经肾活检明确诊断为特发性膜性肾病280例,对伴高血压114例和不伴高血压166例的IMN临床病理特点进行分析,应用Kaplan-Meier曲线分析两组肾脏预后差异,通过单因素COX及多因素COX回归分析肾脏预后的影响因素。结果:伴高血压IMN组的浮肿、糖尿病、年龄、BMI、血压、血尿酸、病理分期、球性硬化、肾小管萎缩、小动脉管壁增厚等高于无高血压组,eGFR低于无高血压组,差异有统计学意义(P均<0.05)。生存分析显示,高血压组肾脏存活率低于无高血压组(P=0.028)。多因素分析显示,舒张压每升高1 mmHg,伴高血压的特发性膜性肾病疾病风险增加15.5%(HR=1.155,P=0.009),平均动脉压每升高1 mmHg,疾病进展风险增加9.0%(HR=1.090,P=0.032)。结论:舒张压及平均动脉压是特发性膜性肾病疾病进展的独立危险因素。

Objective:This study aims to investigate the unique prognostic,clinical,and renal histopathological characteristics of idiopathic membranous nephropathy(IMN)with or without hypertension.Methods:This retrospective observational cohort study included 114 cases of IMN with hypertension and 166 cases of IMN without hypertension treated between January 2008 and September 2019.Prognostic and baseline clinical and histopathological data were compared between the two patient groups,which were proved by renal biopsy.Poor prognostic events included a permanent 50%reduction in eGFR and end stage renal disease(ESRD).A poor event-free renal survival curve was prepared using the Kaplan-Meier method.Univariate and multivariate Cox regression analyses were performed to analyze the correlation between the clinical parameters and renal prognosis.Results:In the hypertension group,significant differences were found in edema,diabetes history,age,body mass index,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),pulse pressure(PP),glycosylated hemoglobin,urea nitrogen,blood uric acid,calculated estimated glomerular filtration rate(eGFR),MN stage,glomerular sclerosis,percentage of glomerular sclerosis,tubular atrophy and vascular lesion compared with the nonhypertension group(all P<0.05).Survival analysis results suggested that patients with hypertension had a lower cumulative renal survival rate than those without hypertension(P=0.028).Multivariate Cox hazards regression analysis results suggested that DBP(HR=1.155,P=0.009)and MAP(HR=1.090,P=0.032)were identified as independent risk factors for the development of IMN with hypertension into 50%decline in eGFR or ESRD,as opposed to those without hypertension.Conclusion:DBP and MAP may be independently associated with renal function decline in IMN patients with hypertension.