IgA肾病患者的肾脏存活及影响因素

目的 探讨IgA肾病患者肾脏生存及其预后影响因素.方法 分析北医三院肾内科肾活检确诊且随访时间在1年以上的IgA肾病患者的临床资料及病理改变,以患者进入终末期肾脏病(ESRD)为随访终点,进行Kaplan-Meier生存分析和多因素Cox回归分析.结果 入选的206例IgA肾病患者的平均随访时间为(60.8±44.7)...

Renal survival of IgA nephropathy and prognosis factors

Objective To investigate the renal survival of IgA nephropathy and analysis the relative risk factors. Methods Clinical and pathologic data of IgA nephropathy confirmed by renal biopsy and followed for at least 1 year were reviewed retrospectively in Peking University Third Hospital. Study endpoint was defined as end stage renal disease (ESRD). Kaplan-Meier survival analysis and Cox regression models were used to analyze renal survival and risk factors of progression respectively. Results 206 eligible cases were analyzed with a median follow-up of (60.8±44.7) months.During the follow-up period,28(13.6%) cases of them reached the endpoint. The cumulative renal survival rate was 95.8% at 1 year,85.1% at 5 years,69.7% at 10 years and 50.9% at 15years. Uni-variate analysis showed that the following parameters at the time of biopsy were significantly correlated with poor renal survival:hypertension (P < 0.001),serum creatinine>132.6μmol/L(P < 0.001),proteinuria>1.5g/d(P < 0.001),hypoalbuminaemia (P < 0.01),Lee’s glomerular grading score (P < 0.001),vascular lesions (P < 0.001) andsegmental glomerulosclerosis in pathology(P < 0.001). The Cox regression analysis revealed that only serum creatinine level (RR=1.02,95%CI 1.01~1.03),urine protein excretion (RR=1.16,95%CI 1.02~1.33) and Lee’s glomerular grading score (RR=2.91,95%CI 1.78~4.77) were independent prognostic indicators. Conclusions Approximately half of the patients with IgA nephropathy may progress into ESRD after fifteen years. Urine protein excretion,serum creatinine and Lee’s glomerular grading system are independent predictors of renal survival of IgA nephropathy.