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目的 分析微量白蛋白尿IgA肾病(IgAN)患者的临床、病理资料,探讨其预后的危险因素.方法 分析本院2009年1月至2014年6月肾活检确诊且随访时间＞6个月的微量白蛋白尿IgAN患者的临床、病理资料,以24 h尿蛋白定量＞1g或肾穿刺时血肌酐值(Scr)正常者出现Scr异常或肾穿刺时Scr异常者出现Scr升高＞1倍为随访终点,进行Kaplan-Meier生存分析和Cox回归模 型分析影响预后的各种危险因素.结果 共96例患者成功进行随访,随访时间为(35.6±22.7)个月,有34例(35.42％)进入随访终点,12、24、36、48、60、72个月的肾生存率分别为97.92％、92.71％、86.45％、81.25％、71.88％、64.58％.尿蛋白、Scr异常、Lee'sⅢ～V级、肾小球硬化、肾间质纤维化、新月体是影响微量白蛋白尿IgAN预后的独立危险因素.结论 早期积极控制尿微量白蛋白,治疗新月体形成所致的急性肾损伤,可延缓IgAN的进展.

Objective To analyze clinical and pathological data of IgA nephrology patients with microalbuminuria and investigate risk factors of its prognosis.Methods Clinical and pathological data of IgA nephrology patients with microalbuminuria were confirmed with renal biopsy and follow-up time with ＞ 6 months of trace was reviewed retrospectively;24-hour urine protein quantification ＞ 1 g, normal serum creatinine level when renal biopsy turned into abnormal level, or doubled serum creatinine level was defined as end point of follow-up.Renal survival was calculated with Kaplan-Meier survival analysis, and risk factors of progression were analyzed with univariate and multivariate Cox regression models.Results A total of 96 patients was followed up successfully, with an average follow-up time of (35.6 ± 22.7) months, and 34 cases (35.42％) entered the endpoint.The 12-, 24-, 36-, 48-, 60-, and 72-month renal survival rate was 97.92％, 92.71％, 86.45％ , 81.25％ , 71.88％, and 64.58％, respectively.Urine proteins, abnormal serum creatinine, Lee's Ⅲ～ V, renal interstitial fibrosis, glomerular sclerosis, and crescentic body were independent risk factors to affect prognosis of IgA nephropathy with microalbuminuria.Conclusions Early and active control of urinary microalbumin, and acute kidney injury caused by treatment of crescentic formation could slow the progress of IgA nephropathy.