摘要目的 探讨炎症性肠病(IBD)合并慢性肾脏病(CKD)的患病率及可能的影响因素.方法 回顾性纳入中山大学附属第六医院2012年3月至2018年3月就诊的IBD患者,根据是否发生CKD分为两组,比较两组患者的临床特征的差异,再采用多因素Logistic回归分析CKD的可能影响因素.结果 2499例IBD患者,平均随访时间(39±18)个月,CKD 151例,总体患病率为6.04％.克罗恩病(CD)患者的CKD患病率高于溃疡性结肠炎(UC)患者(7.22％比3.58％,P<0.05).在9例行肾穿活检的CD患者中,8例为IgA肾病.与非CKD组患者比较,CKD组男性患者更多(78.15％比68.57％,P=0.01),BMI更低(17.72 kg/m2比18.75 kg/m2,P<0.05),病程更长(36个月比24个月,P=0.02),手术率更高(23.18％比11.24％,P<0.05).多因素分析结果表明,男性(OR:1.72,95％CI:1.15～2.58)、有IBD相关肠道手术史者(OR:1.79,95％CI:1.17～2.73)、使用过免疫抑制剂者(OR:2.76,95％CI:1.92～3.97)发生CKD的风险较高,正常BMI者比低BMI者发生CKD的风险较低(OR:0.55,95％CI:0.38～0.80).结论 IBD患者发生CKD并不罕见,男性、IBD相关肠道手术史、使用过免疫抑制剂均是IBD患者发生CKD的危险因素,BMI正常是保护因素.

abstractsObjective To investigate the prevalence and possible influence factors in patients with inflammatory bowel disease(IBD) complicated with chronic kidney disease(CKD). Methods Patients diagnosed as IBD at The Sixth Affiliated Hospital of Sun Yat-sen University,from March 2012 to March 2018 were retrospectively enrolled. These patients were divided into chronic kidney disease group and non-chronic kidney disease group according to the occurrence of CKD. Univariate and multivariate analysis were used to reveal the influence factors of chronic kidney disease. Results A total of 2499 patients with inflammatory bowel disease were enrolled in this study. The follow-up period was(39 ± 18)months. Chronic kidney disease was found in 151 of 2499 patients,the overall prevalence was 6.04％. The prevalence of CKD in Crohn's disease was higher than that in ulcerative colitis(7.22％ vs. 3.58％,P<0.05). Nine of 122 patients of Crohn's disease complicated with chronic kidney disease underwent renal puncture, of whom 8 cases were diagnosed as IgA nephropathy. Compared with the non-chronic kidney disease group, the chronic kidney disease group had more male(78.15％vs. 68.57％,P=0.01),lower BMI(17.72 kg/m2 vs. 18.75kg/m2,P<0.05),longer course of disease(36 months vs. 24 months,P=0.02),higher operation rate(23.18％ vs. 11.24％,P<0.05). Multivariate analysis showed that male(OR:1.72,95％ CI:1.15-2.58),IBD-associated surgical history(OR:1.79,95％CI:1.17-2.73)and the use of immunosuppressive agents(OR:2.76,95％CI:1.92-3.97)were the risk factors of inflammatory bowel disease complicated with chronic kidney disease,while normal BMI rather than low BMI(OR:0.55,95％ CI:0.38-0.80)was the protection factor of inflammatory bowel disease complicated with chronic kidney disease. Conclusions Chronic kidney disease is not rare in patients with inflammatory bowel disease. Male,IBD-associated surgical history and the use of immunosuppressive agents are the risk factors of chronic kidney disease in patients with IBD,while normal BMI is the protection factor.