成人特发性局灶节段性肾小球硬化的预后分析

目的:探讨成人特发性局灶节段性肾小球硬化的远期预后以及相关因素.方法:回顾性分析77例成人特发性局灶节段性肾小球硬化,估算Kaplan-Meier生存曲线,并就预后因素进行单因素和多因素COX回归分析.结果:77例患者平均随访(64.66±25.72)月.终末期肾病患者共17例,无人死亡.25例活检时合并急性肾衰竭的患者中7例进入终末期肾病.5年人、肾存活率分别为100%、83.8%,中位肾生存时间为(116±15.34)月(95%CI 85.93,146.07).单因素分析得出尿蛋白(HR 1.147,P＜0.01)、血肌酐(HR 3.233,P＜0.05)、小管间质慢性损伤(HR 1.684,P＜0.05)、治疗反应(HR 5.607,P＜0.01)与预后相关.多因素分析得出大量蛋白尿(HR1.327,P＜0.01)、小管间质慢性损伤(HR 2.161,P＜0.01)、治疗反应(HR 39.796,P＜0.01)为预后的独立危险因素.结论:中国成人特发性局灶节段性肾小球硬化的5年肾存活率为83.8%.大量蛋白尿、小管间质慢性损伤、治疗无效为预后的独立危险因素.

Long-term outcome of adult patients with idiopathic focal segmental glomerulosclerosis

Objective:To analyze the long-term outcome and prognostic factors of adult idiopathic focal segmental glomerulosclerosis(FSGS).Methodology:Seventy seven adult patients with idopathic FSGS from the Reasarch institute of Nephrology,Jinling Hospital were investigated restrospectively.Survival Curve was estimated by Kaplan-Meier methods,risk factors of renal survival was done by Cox Regression.Results:They were 45 male and 32 female with a mean time of follow-up(64.7±25.7)months.Among them,17 patients progressed to end-stage renal disease without death.7 of 25 cases with acute renal failure at biopsy developed end-stage renal disease.The orerall and renal survival rates were 100% and 83.8%at 5 years after diagnosis,and the median time of renal survival was(116±15.3)months(95%CI 85.9,146).The levels of urine protein excretion(HR 1.147,P＜0.01),and serum creatinine(HR 3.233,P＜0.05),chronic tubulointerstitial injury(HR 1.684,P＜0.0),and treatment response(HR 5.607,P＜0.01)were significant by univariatie analysis.Massive proteinuria(HR 1.327,P＜0.01),chronic tubulointerstitial injury(HR 2.161,P＜0.05)and no response(HR 37.796,P＜0.01)were independent risk factors by multivariate analysis.Conclusion:The 5-year renal survival rate of adult idiopathic FSGS was 83.8%.Massive proteinuria.chronic tubulointerstitial injury and no response were independent risk factors of prognosis.