IgA肾病预后相关危险因素分析

Analysis of risk factors for the prognosis of IgA nephropathy

目的通过分析IgA肾病患者临床及病理资料,探讨影响IgA肾病患者预后的危险因素,为临床提供参考,重视早期诊断及长期随访。方法分析2012年12月—2015年12月于上海交通大学医学院附属仁济医院行肾活检确诊为IgA肾病患者的临床及病理资料,每3个月记录患者血肌酐、24小时蛋白尿等指标,血清肌酐水平比基础值升高50%及以上或进入终末期肾病为终点事件,采用Kaplan-Meier生存分析法分析IgA肾病患者肾脏生存率;用Cox回归分析IgA肾病预后的危险因素。结果共有163例IgA肾病患者在仁济医院长期随访,中位随访时间为29个月,活检中位年龄为33岁,男性82例(50.3%),7例(4.3%)患者进入随访终点,4年肾存活率为86.8%。Cox比例风险模型多因素分析结果显示基线收缩压(HR=1.073,95%CI:1.018~1.132,P=0.009)、时间平均蛋白尿(HR=2.123,95%CI:1.367~3.329,P=0.001)是IgA肾病预后的独立影响因素。结论多种因素和预后相关,而基线收缩压、时间平均蛋白尿是IgA肾病预后的独立影响因素。

Objective To explore the risk factors affecting the prognosis of patients with IgA nephropathy by analyzing the clinical and pathological data of patients with IgA nephropathy,so as to provide clinical reference,and pay attention to early diagnosis and long-term follow-up.Methods The clinical and pathological data of patients with IgA nephropathy who underwent renal biopsy in Renji Hospital from December 2012 to December 2015 were analyzed.Serum creatinine(SCr)and 24-hour urinary protein were recorded every 3 months.The end points were set as SCr increased over 50%or reached end stage renal disease(ESRD)while following up.Kaplan Meier survival analysis was used to analyze the renal survival rate of patients with IgA nephropathy.Cox regression was used to analyze the prognostic risk factors of IgA nephropathy.Results Total 163 IgA nephropathy patients who had long term follow up(median follow up period 29 months)were included.The median age was 33 years old,82(50.3%)were male,7 patients(4.3%)reached the end points and 4-year kidney survival rate was 86.8%.The results of multivariate analysis of Cox proportional risk model showed that baseline systolic blood pressure(HR=1.073,95%CI:1.018-1.132,P=0.009)and time averaged urinary protein excretion(TA-UPE,HR=2.123,95%CI:1.367-3.329,P=0.001)were the independent risk factors for prognosis of IgA nephropathy.Conclusion Various factors are correlated to the prognosis of IgA nephropathy whereas baseline systolic blood pressure and TA-UPE are the independent risk factors.