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| 伴贫血过敏性紫癜肾炎患者的临床特点及预后研究 | |
| 引用本文： | 盛晓笑,翟亚玲,陈雅卓,高静歌,姚星辰,王新念,申娅,张文惠,高歌,程根阳. 伴贫血过敏性紫癜肾炎患者的临床特点及预后研究[J]. 中国全科医学, 2021, 24(29): 3692-3698. DOI: 10.12114/j.issn.1007-9572.2021.01.021 |
| 作者姓名： | 盛晓笑 翟亚玲 陈雅卓 高静歌 姚星辰 王新念 申娅 张文惠 高歌 程根阳 |
| 作者单位： | 450052河南省郑州市，郑州大学第一附属医院肾脏内科 *通信作者：程根阳，教授，主任医师，硕士生导师；E-mail：chengrooter@163.com 注：盛晓笑与翟亚玲为共同第一作者 |
| 基金项目： | 国家自然科学青年基金项目（81600555）；中国博士后科学基金面上项目（2018M640684）；河南省自然科学基金项目（182300410322）；河南省科技攻关计划项目（152102310056） |
| 摘 要： | 背景 过敏性紫癜肾炎（HSPN）是慢性肾脏病的主要原因之一，贫血是其常见表现，且严重影响着患者的生活质量。目的 分析伴贫血HSPN患者的临床特征及对预后的影响。方法 选取2014年12月至2019年6月郑州大学第一附属医院收治的195例HSPN患者。收集患者临床资料〔包括年龄、性别、肾外表现（关节/腹部）及高血压、白细胞计数、血红蛋白、血钙、血磷、血尿素氮、血肌酐、血尿酸、总蛋白、白蛋白、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、估算肾小球滤过率（eGFR）、24 h尿蛋白、尿红细胞（RBC）计数〕、病理资料（包括IgG沉积、IgM沉积、IgA沉积、C3沉积、肾间质纤维化、肾间质炎症、肾小管萎缩、小动脉病变、新月体率、肾小球硬化率、病理分级）。按照患者是否贫血分为贫血组和非贫血组，对患者随访至2019年12月，随访终点事件为复合终点事件，Kaplan-Meier法绘制肾脏预后不良的生存曲线，采用Log-rank检验比较；采用多因素Cox回归模型分析肾脏预后不良的影响因素。结果 贫血组63例，非贫血组132例。贫血组年龄、肾外表现、血尿素氮、24 h尿蛋白、尿RBC计数水平高于非贫血组，血红蛋白、血钙、总蛋白、白蛋白、高密度脂蛋白、eGFR低于非贫血组（P<0.05）。贫血组患者小动脉病变比例及新月体率高于非贫血组（P<0.05）。多因素Cox回归模型分析结果提示，年龄、24 h尿蛋白与肾小球硬化率是肾脏预后不良的影响因素（P<0.05）。贫血组肾脏累积生存率低于非贫血组（χ2=4.675，P=0.031）。结论 伴贫血HSPN患者临床病理表现相对较严重，肾脏累积生存率较低。年龄、24 h尿蛋白与肾小球硬化率是伴贫血HSPN患者肾脏预后不良的影响因素。 |
| 关 键 词： | 肾炎 紫癜性肾炎 贫血 疾病特征 预后 影响因素分析 |
Association of Anemia with Clinicopathological Characteristics and Prognosis in Henoch-Schonlein Purpura Nephritis Patients |
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| SHENG Xiaoxiao,ZHAI Yaling,CHEN Yazhuo,GAO Jingge,YAO Xingchen,WANG Xinnian,SHEN Ya,ZHANG Wenhui,GAO Ge,CHENG Genyang. Association of Anemia with Clinicopathological Characteristics and Prognosis in Henoch-Schonlein Purpura Nephritis Patients[J]. Chinese General Practice, 2021, 24(29): 3692-3698. DOI: 10.12114/j.issn.1007-9572.2021.01.021 | |
| Authors: | SHENG Xiaoxiao ZHAI Yaling CHEN Yazhuo GAO Jingge YAO Xingchen WANG Xinnian SHEN Ya ZHANG Wenhui GAO Ge CHENG Genyang |
| Affiliation: | Department of Nephrology，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China *Corresponding author：CHENG Genyang，Professor，Chief physician，Master supervisor；E-mail：chengrooter@163.com SHENG Xiaoxiao and ZHAI Yaling are co-first authors |
| Abstract: | Background Henoch-Schonlein purpura nephritis（HSPN） is a major cause of chronic kidney disease. Anemia is a common presentation of HSPN，which seriously affects the life quality. Objective To analyze the association of anemia with clinicopathological characteristics and prognosis in HSPN patients. Methods Participants were 195 HSPN patients with and without anemia recruited from the First Affiliated Hospital of Zhengzhou University from December 2014 to July 2019. Clinical data〔including age，gender，baseline extrarenal manifestations（joints/ abdomen），hypertension，white blood cell count，hemoglobin，serum calcium，serum phosphorus，blood urea nitrogen，serum creatinine，serum uric acid，serum total protein，serum albumin，cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein，estimated glomerular filtration rate （eGFR），24-hour urine protein，urinary RBC count〕 and pathological data（including IgG deposition，IgM deposition，IgA deposition，C3 deposition，renal interstitial fibrosis，renal interstitial inflammation，renal tubule atrophy，arteriolar disease，prevalence of crescent formation，glomerulosclerosis rate，pathological grade） were collected. All of them were followed up as of December 2019. Composite adverse outcomes were also collected. Kaplan-Meier curve was plotted to estimate the renal survival. Log-rank test was used to compare the survival of patients with and without anemia. Multivariate Cox regression analysis was adopted to explore the influence factors for prognosis. Results Patients with anemia（n=63） had older mean age，higher rate of having extrarenal manifestations at admission，and higher mean levels of blood urea nitrogen，24-hour urine protein，and urinary RBC count than those without（n=132）（P<0.05）. Moreover，patients with anemia demonstrated lower mean levels of hemoglobin，serum calcium，total protein，albumin，high-density lipoprotein，and eGFR（P<0.05）. Furthermore，greater severity of arteriolar disease and higher prevalence of crescent formation were found in those with anemia（P<0.05）. Multivariate Cox regression analysis suggested that older age，24-hour urine protein and glomerulosclerosis were associated with increased risks of poor prognosis of HSPN（P<0.05）. Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without （χ2=4.675，P=0.031） . Conclusion HSPN patients with anemia presented more serious clinicopathological features，and a lower renal cumulative survival rate. Older age，24-hour urine protein and glomerulosclerosis may be influence factors for composite adverse outcomes. |
| Keywords: | Nephritis Henoch-schonlein purpura nephritis Anemia Disease attributes Prognosis Root cause analysis |
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