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- 2015
IgA肾病肾组织血管病变分析
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Abstract:
目的:分析IgA肾病肾组织血管病变与临床、病理改变及预后的关系。方法:选择肾活检确诊为原发性IgA肾病的1 699例患者,观察肾血管病变发生情况,分析患者临床病理改变及预后。终点事件定义为估计的肾小球滤过率(eGFR)下降50%(排除急性肾损伤)或患者进入透析。结果:1 699例中,1 010例(59.4%)有肾组织血管病变。与无血管病变组比较,有肾组织血管病变组高血压患者比例高(χ2=49.480,P<0.001),活检时eGFR低(Z=1.720,P<0.001),系膜细胞增生患者比例、球性硬化及新月体比例高(χ2=11.478,Z=17.072、7.011,P<0.001),小管萎缩程度重(χ2=682.385,P<0.001),随访期间eGFR下降速度更快(Z=2.763,P=0.006)。随访期间,有肾组织血管病变组发生肾脏终点事件249例,无血管病变组无终点事件发生,两组生存曲线差异有统计学意义(χ2=13.196,P<0.001)。但Cox回归提示血管病变不是IgA肾病进入终点,事件的独立预测因子[HR(95%CI)=0.42(0.02～7.26)]。结论:肾组织血管病变在IgA肾病中普遍存在; 存在肾组织血管病变的IgA肾病患者临床、病理损伤程度重,预后差。
Aim: To estimate the value of vascular lesion for predicting renal outcomes in patients with IgA nephropathy(IgAN).Methods: A total of 1 699 cases of IgAN with renal biopsy-proven were collected to evaluate and analyze vascular lesions,clinical pathological features and renal outcomes. The primary renal endpoint was a 50% reduction in estimated glomerular filtration rate(eGFR)or end-stage renal disease.Results: A total of 1 010(59.4%)patients had vascular lesions. Compared with those of the patients without vascular lesions,at the time of renal biopsy, the patients with vascular lesions showed a higher hypertension occurence(χ2=49.480,P<0.001), lower eGFR(Z=1.720,P<0.001), a higher mesangial proliferation occurence(χ2=11.487,P<0.001),higher percentages of obsolete glomeruli and crescent(Z=17.072 and 7.011,P<0.001), more serious tubular atrophy(χ2=682.385,P<0.001),and faster eGFR descent(Z=2.763,P=0.006)during the follow-up.A total of 249 cases reached renal endpoint, and all of them were in the vascular lesions group,the Kaplan-Meier survival curve between the vasular lesion group and non-vascular lesion group had significant difference(χ2=13.196,P<0.001), but Cox model did not show that the presence of renal vascular lesions was an independent risk factor for renal outcomes[HR(95%CI)=0.42(0.02-7.26)].Conclusion:The vascular lesions is common in IgAN, and might predict serious clinical and pathological lesions, and bad renal outcomes
