特发性膜性肾病患者早期蛋白尿未缓解的影响因素分析

Influencing factors of early non-remission of proteinuria in patients with idiopathic membranous nephropathy

目的探讨肾脏病理表现为特发性膜性肾病(idiopathic membranous nephropathy, IMN)的肾病综合征(nephrotic syndrome, NS)患者早期蛋白尿未缓解的影响因素。方法回顾性观察研究, 收集首都医科大学附属北京安贞医院2010年6月1日至2022年1月31日经肾活检明确诊断为IMN且治疗6个月后血清白蛋白恢复正常NS患者的临床资料, 根据尿蛋白量是否 < 3.5 g/24 h且尿蛋白量下降≥基线值的50%分为蛋白尿缓解组和蛋白尿未缓解组。比较两组基线临床及病理表现特征的差异。应用Logistic回归模型分析蛋白尿未缓解的影响因素。结果 95例肾脏病理诊断为IMN的NS患者入选本研究, 年龄57(43, 65)岁, 男性50例(52.6%), 其中蛋白尿缓解组75例, 蛋白尿未缓解组20例。与蛋白尿缓解组比较, 蛋白尿未缓解组患者基线体重指数[(26.83±4.03)kg/m^(2)比(24.68±3.97)kg/m^(2), t=-2.149, P=0.034]和超重比例(85.0%比58.7%, χ^(2)=4.765, P=0.029)均较高, 基线腰围较大[88.5(85.3, 101.5)cm比87.0(77.5, 92.0)cm, Z=2.362, P=0.018]。肾脏病理检查结果显示, 与蛋白尿缓解组比较, 蛋白尿未缓解组合并糖尿病肾病比例(10.0%比0, P=0.043)和伴肾小球肥大比例(45.0%比20.0%, χ^(2)=5.227, P=0.022)均较高, 肥大肾小球平均直径较长[(197.96±6.37)μm比(193.51±8.50)μm, t=2.029, P=0.041]。多因素Logistic回归分析结果显示, 男性腰围> 90 cm和女性腰围> 85 cm时, 腰围是IMN患者蛋白尿未缓解的独立影响因素(OR=1.083, 95%CI 1.005~1.168, P=0.037)。结论腹型肥胖是肾脏病理表现为IMN的NS患者早期治疗后蛋白尿未缓解的独立危险因素。

Objective To investigate the influencing factors of non-remission of proteinuria in patients with nephrotic syndrome(NS)and idiopathic membranous nephropathy(IMN).Methods The study was a retrospective observational study.The clinical data of patients with NS who were diagnosed as IMN by renal biopsy and serum albumin recovered normal after six months of treatment were collected from Beijing Anzhen Hospital,Capital Medical University from June 1,2010 to January 31,2022.Patients were divided into proteinuria remission group and non-proteinuria remission group according to whether urinary protein<3.5 g/24 h and decreased 50%from the onset.The differences of clinical and pathological characteristics between the two groups at baseline were compared.The logistic regression model was used to analyze the influencing factors of non-remission of proteinuria.Results Ninety-five NS patients with renal pathology of IMN were included in this study,with age of 57(43,65)years old and 50 males(52.6%).There were 75 patients in the proteinuria remission group and 20 patients in the non-proteinuria remission group.Compared with the proteinuria remission group,the non-proteinuria remission group had higher baseline body mass index[(26.83±4.03)kg/m^(2)vs.(24.68±3.97)m^(2),t=-2.149,P=0.034]and proportion of overweight(85.0%vs.58.7%,χ^(2)=4.765,P=0.029),and larger waist circumference[88.5(85.3,101.5)cm vs.87.0(77.5,92.0)cm,Z=2.362,P=0.018].Renal pathological results showed that the proportions of diabetes nephropathy(10.0%vs.0,P=0.043)and glomerular hypertrophy(45.0%vs.20.0%,χ^(2)=5.227,P=0.022)were higher,and the average diameter of hypertrophic glomeruli was longer[(197.96±6.37)μm vs.(193.51±8.50)μm,t=2.029,P=0.041]in the proteinuria remission group than those in the non-proteinuria remission group.Multivariate logistic regression analysis results showed that waist circumference was an independent influencing factor of non-proteinuria remission in patients with IMN under waist circumference>90 cm in men and>85 cm in women(OR=1.083,95%CI 1.005-1.168,P=0.037).Conclusion Abdominal obesity is an independent risk factor of non-remission of proteinuria in NS patients with IMN after early treatment.