原发性IgA肾病(IgA nephropathy,IgAN)是一种常见的肾小球疾病,是导致肾功能衰竭的重要原因,主要见于青年人和儿童。在过去的几十年里,糖皮质激素疗法一直备受争议。IgA肾病激素治疗评估的全球研究(the therapeutic effects of steroids...原发性IgA肾病(IgA nephropathy,IgAN)是一种常见的肾小球疾病,是导致肾功能衰竭的重要原因,主要见于青年人和儿童。在过去的几十年里,糖皮质激素疗法一直备受争议。IgA肾病激素治疗评估的全球研究(the therapeutic effects of steroids in IgA nephropathy global,TESTING)始于2012年,是一项国际性、多中心、双盲、随机、安慰剂对照试验,旨在评估在优化支持治疗条件下口服甲泼尼龙治疗进展风险高的IgAN患者的安全性和长期疗效。经过十年的努力,这项研究的成功完成表明,6~9个月的口服甲泼尼龙是保护IgAN高危患者肾功能的有效方案,但也显示出安全问题。TESTING研究发现,与全剂量甲泼尼龙方案相比,减少剂量的甲泼尼龙方案是有益的,且剂量的减少有助于提高甲泼尼龙的使用安全性。总的来说,TESTING研究提供了更多关于IgAN中糖皮质激素治疗剂量和安全性的数据。TESTING研究结果给患有IgAN的患儿提供了重要的启示。随着对IgAN发病机制的深入了解,正在进行的新治疗方案的研究将有助于进一步优化IgAN治疗的获益-风险比。展开更多
目的扁桃体切除术治疗IgA肾病(IgAN)的疗效目前仍存在争议,这项meta分析旨在评价其作为辅助或独立治疗的疗效,为其在临床中的应用提供更充分的循证学依据。方法计算机检索建库至2022年11月1日在Pubmed、Embase、ScienceDirect、Cochrane...目的扁桃体切除术治疗IgA肾病(IgAN)的疗效目前仍存在争议,这项meta分析旨在评价其作为辅助或独立治疗的疗效,为其在临床中的应用提供更充分的循证学依据。方法计算机检索建库至2022年11月1日在Pubmed、Embase、ScienceDirect、Cochrane library、Web of Science、中国知网(CNKI)、维普网(VIP)、中国生物医学文献数据库(CBM)和万方数据库公开发表的关于扁桃体切除术治疗IgAN的文献,以蛋白尿、血尿、完全缓解率及终末期肾病(ESRD)发生率作为观察点,使用Stata 12.0软件进行统计学分析。结果共纳入36篇文献,涉及5797名原发性IgAN患者。Meta分析结果显示,扁桃体切除术作为辅助或独立治疗手段与单纯药物治疗相比,蛋白尿缓解率显著增加(OR=4.44,95%CI:3.14~6.27),血尿缓解率显著增加(OR=5.11,95%CI:2.92~8.93),完全缓解率显著增加(OR=3.32,95%CI:2.79~3.96),而ESRD发生率显著降低(OR=0.24,95%CI:0.17~0.33)。结论扁桃体切除术作为辅助或独立治疗手段,有助于诱导临床缓解并抑制终末期肾病的进展,临床上应更加重视其应用价值。展开更多
Objective:To explore the clinicopathological characteristics of IgA nephropathy(IgAN)patients with anemia.Methods:The clinical and pathological data of patients diagnosed with primary IgAN at the Renmin Hospital of Wu...Objective:To explore the clinicopathological characteristics of IgA nephropathy(IgAN)patients with anemia.Methods:The clinical and pathological data of patients diagnosed with primary IgAN at the Renmin Hospital of Wuhan University from January 2017 to December 2019 were colleted.The patients were divided into anemia group and without anemia group based on the pressure value when performing the Kidney kidney biopsy.Compare the data of the two groups of patients.Results:A total of 314 subjects were enrolled,including 181 females(57.64%),and the female-male ratio was 1.36∶1.Their age was(37±13)years.There were 113 patients(35.99%)in anemia group,201 cases(64.01%)in non-anemic group.Univariate analysis showed that compared with non-anemia group,anemia group had higher serum creatinine and 24h urine protein levels,higher proportion of females and eGFR<60 ml·min^(-1)·(1.73m^(2))^(-1),lower serum albumin,higher proportion of tubular atrophy/interstitial fibrosis(T1/2),endothelial cell proliferation(E1)and crescent formation(C1/2),which were statistically significant(all P<0.05).Anemia group had a higher proportion of Ⅳ~Ⅴlevel in Lee's classification.There was a difference in Lee's grading composition between the two groups,and the difference was statistically significant(P<0.01).Spearson correlation analysis showed that the glomerular and tubulointerstitial lesions were negatively correlated with serum hemoglobin、albumin and eGFR,but positively corelated with proteinuria(P<0.05).Multivariate Logistic regression analysis found that decreased serum albumin level,increased serum creatinine and hypertension were independent risk factors for anemia in IgAN patients.Conclusions:Anemia can aggravate the pathological damage and clinical manifestations in patients with IgA nephropathy.The anemia must be corrected in time during treatment and follow-up.At the same time.it should be paid more attention to the changes of serum albumin level,blood pressure monitoring and the protection of renal function.展开更多
目的:探讨不同尿红细胞水平与IgA肾病患者临床指标、病理、及预后的关系。方法:经肾活检确诊为原发性IgA肾病患者,根据时间平均尿红细胞(time average urinary red blood cell,TA-uRBC)检测结果的三分位数分为低、中、高三组,分析比较...目的:探讨不同尿红细胞水平与IgA肾病患者临床指标、病理、及预后的关系。方法:经肾活检确诊为原发性IgA肾病患者,根据时间平均尿红细胞(time average urinary red blood cell,TA-uRBC)检测结果的三分位数分为低、中、高三组,分析比较各组的临床病理及预后,主要结局事件定义为死亡,或到达肾脏结局[包含终末期肾衰竭(透析,移植),或肾小球滤过率下降大于40%]。结果:共纳入540例IgAN患者,尿红细胞水平与年龄(r=-0.142,P=0.001)、平均动脉压(r=-0.094,P=0.049)、与eGFR水平(r=0.091,P=0.04)正相关。尿红细胞水平与病理损伤中的新月体比例(r=0.196,P<0.0001)、系膜细胞增生程度(r=0.097,P=0.03)、毛细血管内细胞增生程度(r=0.093,P=0.04)呈正相关。与节段性硬化、小管萎缩/间质纤维化无相关性(P>0.05)。随访65(IQR 51.00~103.00)个月,随访期间共计40例患者(7.41%)到达终点事件,其中6例进入ESRD,34例GFR下降>40%。Kaplan-Meier生存分析结果表明低、中、高组的肾脏生存率依次降低(P=0.045);多因素COX回归提示TA-uRBC每升高10/HP,肾功能进展至结局的风险增加45.4%,(95%CI 1.185~1.785),P=0.0003。进一步进行亚组分析,对24 h尿蛋白定量>0.74 g(中位数)的患者,各组生存曲线差异有统计学意义(P=0.045),肾脏预后与TA-uRBC水平(r=1.063,P=0.0005)正相关;而24 h尿蛋白定量<0.74 g的患者各组间则差异无统计学意义。结论:IgA肾病血尿水平与新月体形成正相关。持续存在血尿且其平均水平与IgAN的预后相关。展开更多
目的研究厄贝沙坦联合他克莫司治疗IgA肾病的效果及对肾功能指标、炎症-免疫状态的影响。方法以2021年10月至2022年10月商丘市第一人民医院收治的80例IgA肾病患者为研究对象,采用随机数字表法分为对照组、联合组,各40例。对照组采用厄...目的研究厄贝沙坦联合他克莫司治疗IgA肾病的效果及对肾功能指标、炎症-免疫状态的影响。方法以2021年10月至2022年10月商丘市第一人民医院收治的80例IgA肾病患者为研究对象,采用随机数字表法分为对照组、联合组,各40例。对照组采用厄贝沙坦治疗,联合组采用厄贝沙坦联合他克莫司治疗。比较两组临床疗效,治疗前及治疗2个月后肾功能指标[24 h尿蛋白定量(24 h Upro)、血肌酐(Scr)、肾小球滤过率(eGFR)、尿素氮(BUN)],免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)),血清细胞因子[肿瘤坏死因子-α(TNF-α)、单核趋化因子-1(MCP-1)、S100钙结合蛋白A8/A9复合物(S100A8/A9)、核转录因子-κB(NF-κB)]水平,不良反应发生率。结果联合组临床总有效率(92.50%)高于对照组(75.00%)(P<0.05);与治疗前相比,两组治疗2个月后24 h Upro、Scr、BUN水平均降低,eGFR均升高,且联合组变动幅度大于对照组(P<0.05);与治疗前相比,两组治疗2个月后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均升高,且联合组高于对照组(P<0.05);与治疗前相比,两组治疗2个月后血清TNF-α、MCP-1、S100A8/A9、NF-κB水平均降低,且联合组低于对照组(P<0.05);联合组不良反应总发生率(12.50%)与对照组(7.50%)差异无统计学意义(P>0.05)。结论采用厄贝沙坦联合他克莫司治疗IgA肾病患者可显著提高疗效,抑制炎性因子表达,改善肾功能及免疫功能。展开更多
Hepatitis C virus (HCV) infection is a systemic disorder which is often associated with a number of extrahepatic manifestations including glomerulopathies. Patients with HCV infection were found to have a higher risk ...Hepatitis C virus (HCV) infection is a systemic disorder which is often associated with a number of extrahepatic manifestations including glomerulopathies. Patients with HCV infection were found to have a higher risk of end-stage renal disease. HCV positivity has also been linked to lower graft and patient survivals after kidney transplantation. Various histological types of renal diseases are reported in association with HCV infection including membranoproliferative glomerulonephritis (MPGN), membranous nephropathy, focal segmental glomerulosclerosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, IgA nephropathy, renal thrombotic microangiopathy, vasculitic renal involvement and interstitial nephritis. The most common type of HCV associated glomerulopathy is type I MPGN associated with type II mixed cryoglobulinemia. Clinically, typical renal manifestations in HCV-infected patients include proteinuria, microscopic hematuria, hypertension, acute nephritis and nephrotic syndrome. Three approaches may be suggested for the treatment of HCV-associated glomerulopathies and cryoglobulinemic renal disease: (1) antiviral therapy to prevent the further direct damage of HCV on kidneys and synthesis of immune-complexes; (2) B-cell depletion therapy to prevent formation of immune-complexes and cryoglobulins; and (3) nonspecific immunosuppressive therapy targeting inflammatory cells to prevent the synthesis of immune-complexes and to treat cryoglobulin associated vasculitis. In patients with moderate proteinuria and stable renal functions, anti-HCV therapy is advised to be started as pegylated interferon-α plus ribavirin. However in patients with nephrotic-range proteinuria and/or progressive kidney injury and other serious extra-renal manifestations, immunosuppressive therapy with cyclophosphamide, rituximab, steroid pulses and plasmapheresis should be administrated.展开更多
文摘原发性IgA肾病(IgA nephropathy,IgAN)是一种常见的肾小球疾病,是导致肾功能衰竭的重要原因,主要见于青年人和儿童。在过去的几十年里,糖皮质激素疗法一直备受争议。IgA肾病激素治疗评估的全球研究(the therapeutic effects of steroids in IgA nephropathy global,TESTING)始于2012年,是一项国际性、多中心、双盲、随机、安慰剂对照试验,旨在评估在优化支持治疗条件下口服甲泼尼龙治疗进展风险高的IgAN患者的安全性和长期疗效。经过十年的努力,这项研究的成功完成表明,6~9个月的口服甲泼尼龙是保护IgAN高危患者肾功能的有效方案,但也显示出安全问题。TESTING研究发现,与全剂量甲泼尼龙方案相比,减少剂量的甲泼尼龙方案是有益的,且剂量的减少有助于提高甲泼尼龙的使用安全性。总的来说,TESTING研究提供了更多关于IgAN中糖皮质激素治疗剂量和安全性的数据。TESTING研究结果给患有IgAN的患儿提供了重要的启示。随着对IgAN发病机制的深入了解,正在进行的新治疗方案的研究将有助于进一步优化IgAN治疗的获益-风险比。
文摘目的扁桃体切除术治疗IgA肾病(IgAN)的疗效目前仍存在争议,这项meta分析旨在评价其作为辅助或独立治疗的疗效,为其在临床中的应用提供更充分的循证学依据。方法计算机检索建库至2022年11月1日在Pubmed、Embase、ScienceDirect、Cochrane library、Web of Science、中国知网(CNKI)、维普网(VIP)、中国生物医学文献数据库(CBM)和万方数据库公开发表的关于扁桃体切除术治疗IgAN的文献,以蛋白尿、血尿、完全缓解率及终末期肾病(ESRD)发生率作为观察点,使用Stata 12.0软件进行统计学分析。结果共纳入36篇文献,涉及5797名原发性IgAN患者。Meta分析结果显示,扁桃体切除术作为辅助或独立治疗手段与单纯药物治疗相比,蛋白尿缓解率显著增加(OR=4.44,95%CI:3.14~6.27),血尿缓解率显著增加(OR=5.11,95%CI:2.92~8.93),完全缓解率显著增加(OR=3.32,95%CI:2.79~3.96),而ESRD发生率显著降低(OR=0.24,95%CI:0.17~0.33)。结论扁桃体切除术作为辅助或独立治疗手段,有助于诱导临床缓解并抑制终末期肾病的进展,临床上应更加重视其应用价值。
基金National Key Technology R&D Program(No.2017HX0002,2015BAI12B06)National Natural Science Foundation of China(No.81700599)。
文摘Objective:To explore the clinicopathological characteristics of IgA nephropathy(IgAN)patients with anemia.Methods:The clinical and pathological data of patients diagnosed with primary IgAN at the Renmin Hospital of Wuhan University from January 2017 to December 2019 were colleted.The patients were divided into anemia group and without anemia group based on the pressure value when performing the Kidney kidney biopsy.Compare the data of the two groups of patients.Results:A total of 314 subjects were enrolled,including 181 females(57.64%),and the female-male ratio was 1.36∶1.Their age was(37±13)years.There were 113 patients(35.99%)in anemia group,201 cases(64.01%)in non-anemic group.Univariate analysis showed that compared with non-anemia group,anemia group had higher serum creatinine and 24h urine protein levels,higher proportion of females and eGFR<60 ml·min^(-1)·(1.73m^(2))^(-1),lower serum albumin,higher proportion of tubular atrophy/interstitial fibrosis(T1/2),endothelial cell proliferation(E1)and crescent formation(C1/2),which were statistically significant(all P<0.05).Anemia group had a higher proportion of Ⅳ~Ⅴlevel in Lee's classification.There was a difference in Lee's grading composition between the two groups,and the difference was statistically significant(P<0.01).Spearson correlation analysis showed that the glomerular and tubulointerstitial lesions were negatively correlated with serum hemoglobin、albumin and eGFR,but positively corelated with proteinuria(P<0.05).Multivariate Logistic regression analysis found that decreased serum albumin level,increased serum creatinine and hypertension were independent risk factors for anemia in IgAN patients.Conclusions:Anemia can aggravate the pathological damage and clinical manifestations in patients with IgA nephropathy.The anemia must be corrected in time during treatment and follow-up.At the same time.it should be paid more attention to the changes of serum albumin level,blood pressure monitoring and the protection of renal function.
文摘目的研究厄贝沙坦联合他克莫司治疗IgA肾病的效果及对肾功能指标、炎症-免疫状态的影响。方法以2021年10月至2022年10月商丘市第一人民医院收治的80例IgA肾病患者为研究对象,采用随机数字表法分为对照组、联合组,各40例。对照组采用厄贝沙坦治疗,联合组采用厄贝沙坦联合他克莫司治疗。比较两组临床疗效,治疗前及治疗2个月后肾功能指标[24 h尿蛋白定量(24 h Upro)、血肌酐(Scr)、肾小球滤过率(eGFR)、尿素氮(BUN)],免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)),血清细胞因子[肿瘤坏死因子-α(TNF-α)、单核趋化因子-1(MCP-1)、S100钙结合蛋白A8/A9复合物(S100A8/A9)、核转录因子-κB(NF-κB)]水平,不良反应发生率。结果联合组临床总有效率(92.50%)高于对照组(75.00%)(P<0.05);与治疗前相比,两组治疗2个月后24 h Upro、Scr、BUN水平均降低,eGFR均升高,且联合组变动幅度大于对照组(P<0.05);与治疗前相比,两组治疗2个月后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均升高,且联合组高于对照组(P<0.05);与治疗前相比,两组治疗2个月后血清TNF-α、MCP-1、S100A8/A9、NF-κB水平均降低,且联合组低于对照组(P<0.05);联合组不良反应总发生率(12.50%)与对照组(7.50%)差异无统计学意义(P>0.05)。结论采用厄贝沙坦联合他克莫司治疗IgA肾病患者可显著提高疗效,抑制炎性因子表达,改善肾功能及免疫功能。
文摘Hepatitis C virus (HCV) infection is a systemic disorder which is often associated with a number of extrahepatic manifestations including glomerulopathies. Patients with HCV infection were found to have a higher risk of end-stage renal disease. HCV positivity has also been linked to lower graft and patient survivals after kidney transplantation. Various histological types of renal diseases are reported in association with HCV infection including membranoproliferative glomerulonephritis (MPGN), membranous nephropathy, focal segmental glomerulosclerosis, fibrillary glomerulonephritis, immunotactoid glomerulopathy, IgA nephropathy, renal thrombotic microangiopathy, vasculitic renal involvement and interstitial nephritis. The most common type of HCV associated glomerulopathy is type I MPGN associated with type II mixed cryoglobulinemia. Clinically, typical renal manifestations in HCV-infected patients include proteinuria, microscopic hematuria, hypertension, acute nephritis and nephrotic syndrome. Three approaches may be suggested for the treatment of HCV-associated glomerulopathies and cryoglobulinemic renal disease: (1) antiviral therapy to prevent the further direct damage of HCV on kidneys and synthesis of immune-complexes; (2) B-cell depletion therapy to prevent formation of immune-complexes and cryoglobulins; and (3) nonspecific immunosuppressive therapy targeting inflammatory cells to prevent the synthesis of immune-complexes and to treat cryoglobulin associated vasculitis. In patients with moderate proteinuria and stable renal functions, anti-HCV therapy is advised to be started as pegylated interferon-α plus ribavirin. However in patients with nephrotic-range proteinuria and/or progressive kidney injury and other serious extra-renal manifestations, immunosuppressive therapy with cyclophosphamide, rituximab, steroid pulses and plasmapheresis should be administrated.
