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毛细血管内细胞增多性病变在IgA肾病临床进展及免疫抑制治疗中的意义

The effect of endocapillary hypercellularity lesions on the renal prognosis and response to immunosuppressive therapy in IgA nephropathy

摘要:

探索毛细血管内细胞增多(E)病变尤其是弥漫性E病变在IgA肾病临床进展及治疗中的意义。选随访时间超过12个月的IgA肾病合并E病变者365例,其中IgA肾病合并弥漫性E病变者31例;通过倾向性匹配方法,按1∶1比例选基线数据与研究人群相匹配的IgA肾病未合并E病变者769例。以基线估算肾小球滤过率(eGFR)下降30%、终末期肾病为混合研究终点。分析患者的肾脏生存情况。结果显示,(1)中位随访41个月, Kaplan-Meier分析显示,合并E病变IgA肾病者(130例)肾脏生存率1年为96.0%,3年为83.6%,5年为67.7%;未合并E病变IgA肾病者(131例)肾脏生存率1年为96.9%,3年为83.6%,5年为68.7%;两者比较差异无统计学意义( P=0.265)。其中接受免疫抑制剂治疗者发生终点事件的 HR=1.038,95% CI 0.749~1.440;未接受免疫抑制治疗者发生终点事件的 HR=1.113,95% CI0.770~1.609;差异无统计学意义( P=0.781)。(2)中位随访52.5个月, Kaplan-Meier分析显示,合并弥漫性E病变IgA肾病者(7例)肾脏生存率1年为100.0%,3年为96.2%,5年为74.5%;未合并E病变IgA肾病者(11例)肾脏生存率1年为96.2%,3年为82.3%,5年为63.7%;两者比较差异无统计学意义( P=0.158)。其中接受免疫抑制剂治疗者发生终点事件的 HR=0.625,95% CI0.213~1.839;未接受免疫抑制治疗者发生终点事件的 HR=0.447,95% CI 0.028~7.191;差异无统计学意义( P=0.825)。在现有的治疗模式下,尚无明确证据表明合并E病变,包括弥漫性E病变的IgA肾病具有进一步加强免疫抑制治疗以改变预后的提示意义。

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abstracts:

In this retrospective cohort study, we aim to evaluate the effect of endocapillary hypercellularity (E) lesions on the renal prognosis and response to immunosuppressive therapy, especially diffuse endocapillary hypercellularity lesion in IgA nephropathy (IgAN). A total of 365 patients with IgAN and E lesions and 31 patients with diffuse E lesions and over 12-month follow-up period were included in this study. We performed an 1∶1 propensity score to identify controls with matched clinical and pathological features from 769 IgAN patients without E lesions. The end-point was defined as a 30% decrease in estimated glomerular filtration rate (eGFR) or end-stage kidney disease. The kidney survival of the two groups was compared by Kaplan-Meier analysis. During median follow-up period of 41 months, kidney survival rates in patients with E lesions were 96.0% at 1 year, 83.6% at 3 years, 67.7% at 5 years; while they were 96.9% at 1 year, 83.6% at 3 years, and 68.7% at 5 years in patients without E lesions ( P=0.265).The HRof immunosuppressive therapy was 1.038 (95% CI 0.749-1.440) and 1.113 (95% CI 0.770-1.609) in patients not receiving immunosuppressive therapy ( P=0.781). (2) During median follow-up period of 52.5 months, the kidney survival rates in patients with diffuse E-lesion were 100.0% at 1 year, 96.2% at 3 years, 74.5% at 5 years; while they were 96.2% at 1 year, 82.3% at 3 years, and 63.7% at 5 years in patients without E-lesion ( P=0.158). The HR of immunosuppressive therapy was 0.625 (95% CI 0.213-1.839) and 0.447 (95% CI 0.028-7.191) in patients not receiving immunosuppressive therapy ( P=0.825). E lesion or diffuse E lesion may not be associated with prognosis or response to immunosuppressive therapy.

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