克罗恩病合并蛋白尿的危险因素分析

Risk Factors of Proteinuria in Patients with Crohn’s Disease

目的:炎症性肠病合并肾损害已被广泛报道,蛋白尿是肾脏损害的标志,本文的目的是探讨克罗恩病患者蛋白尿形成的危险因素。方法:在此次回顾性研究中,纳入了在2018年01月01日—2021年01月01日确诊为克罗恩病患者,根据入院晨尿常规检查蛋白尿结果,将患者分为蛋白尿组(≥1+)和非蛋白尿组(阴性或微量),比较两组之间临床特点的差异,将P值<0.1的因素纳入多因素logistic模型中,采用前进法得出最后的模型。结果:共纳入203例符合条件的患者,将患者的一般人口学信息、尿常规、血清的生化检查、免疫学、原发病以及其并发症的指标纳入分析,单因素分析发现几个可能的影响因素,如生物制剂的使用、克罗恩病病程等,多因素分析结果显示,生物制剂的使用(OR:8.133,95%CI:1.327~49.843)、血尿(OR:16.167,95%CI:3.606~72.481)、尿管型(OR:6.755,95%CI:1.381~33.035)、血肌酐升高(OR:1.046,95%CI:1.016~1.077)和血清IgA/C3升高(OR:2.524,95%CI:1.223~5.209)是克罗恩病合并蛋白尿危险因素,而血清IgG升高(OR:0.594,95%CI:0.436~0.808)是保护性因素。结论:克罗恩病患者出现蛋白尿可能与肠道免疫以及生物制剂应用相关,在进行原发病的治疗过程中,需要警惕药物性肾损害。

Objective:Renal complications of inflammatory bowel disease has been well documented.Proteinuria was a marker of renal injury.The purpose of this study was to analyze the risk factors of proteinuria in Crohn’s disease.Methods:In this retrospective study,patients diagnosed with Crohn's disease from January 1,2018 to January 1,2021 were divided into proteinuria group(≥1+)and non-proteinuria group(negative or trace)according to the results of proteinuria detected by routine urinalysis of morning urine at admission.The differences in clinical characteristics between the two groups were compared.Factors with P<0.1 were included in the multivariate logistic model and forward method was used in the final model.Results:A total of 203 eligible patients were enrolled.The indexes of general demographic information,routine urinalysis,serum biochemical examination,immunology,primary disease and its complications were included in the analysis.Univariate analysis demonstrated several possible significant factors,such as the use of biological agents,the course of Crohn's disease and etc.Multivariate analysis showed that the use of biological agents(OR:8.133,95%CI:1.327~49.843),hematuria(OR:16.167,95%CI:3.606~72.481),urinary cast(OR:6.755,95%CI:1.381~33.035),the elevated serum creatinine(OR:1.046,95%CI:1.016~1.077)and the elevated serum IgA/C3(OR:2.524,95%CI:1.223~5.209)were risk factors of proteinuria in Crohn’s disease,while the elevated serum IgG(OR:0.594,95%CI:0.436~0.808)was a protective factor.Conclusion:Proteinuria in patients with Crohn’s disease may be associated with intestinal immunity and the use of biological agents.During the treatment of the primary disease,it is necessary to guard against drug-induced renal damage.