IgA肾病预后相关危险因素分析

范晶; 黄冠文; 包继文; 张敏芳; 周文彦; 王琴; 倪兆慧; 王玲

doi:10.16766/j.cnki.issn.1674-4152.002441

IgA肾病预后相关危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002441

范晶^{1, 2},
黄冠文¹,
包继文¹,
张敏芳¹,
周文彦¹,
王琴¹,
倪兆慧¹,
王玲^1, ,

1.
上海交通大学医学院附属仁济医院肾脏科，上海 200127
2.
上海市闵行区颛桥社区卫生服务中心，上海 201108

基金项目:

上海市自然科学基金项目 19ZR1430800

上海申康专科疾病临床“五新”转化项目 16CR3022A

详细信息

通讯作者:
王玲，E-mail：shwangling@126.com

中图分类号: R692.6
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- 被引次数: 0
出版历程
- 收稿日期: 2021-05-25
- 网络出版日期: 2022-09-05

Analysis of risk factors for the prognosis of IgA nephropathy

1.
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China

摘要

摘要: 目的通过分析IgA肾病患者临床及病理资料，探讨影响IgA肾病患者预后的危险因素，为临床提供参考，重视早期诊断及长期随访。方法分析2012年12月—2015年12月于上海交通大学医学院附属仁济医院行肾活检确诊为IgA肾病患者的临床及病理资料，每3个月记录患者血肌酐、24小时蛋白尿等指标，血清肌酐水平比基础值升高50%及以上或进入终末期肾病为终点事件，采用Kaplan-Meier生存分析法分析IgA肾病患者肾脏生存率；用Cox回归分析IgA肾病预后的危险因素。结果共有163例IgA肾病患者在仁济医院长期随访, 中位随访时间为29个月，活检中位年龄为33岁，男性82例(50.3%)，7例(4.3%)患者进入随访终点，4年肾存活率为86.8%。Cox比例风险模型多因素分析结果显示基线收缩压(HR=1.073，95%CI：1.018~1.132，P=0.009)、时间平均蛋白尿(HR=2.123，95%CI：1.367~3.329，P=0.001)是IgA肾病预后的独立影响因素。结论多种因素和预后相关，而基线收缩压、时间平均蛋白尿是IgA肾病预后的独立影响因素。
- IgA肾病 /
- 预后 /
- 危险因素
Abstract: Objective To explore the risk factors affecting the prognosis of patients with IgA nephropathy by analyzing the clinical and pathological data of patients with IgA nephropathy, so as to provide clinical reference, and pay attention to early diagnosis and long-term follow-up. Methods The clinical and pathological data of patients with IgA nephropathy who underwent renal biopsy in Renji Hospital from December 2012 to December 2015 were analyzed. Serum creatinine (SCr) and 24-hour urinary protein were recorded every 3 months. The end points were set as SCr increased over 50% or reached end stage renal disease (ESRD) while following up. Kaplan Meier survival analysis was used to analyze the renal survival rate of patients with IgA nephropathy. Cox regression was used to analyze the prognostic risk factors of IgA nephropathy. Results Total 163 IgA nephropathy patients who had long term follow up (median follow up period 29 months) were included. The median age was 33 years old, 82(50.3%) were male, 7 patients (4.3%) reached the end points and 4-year kidney survival rate was 86.8%. The results of multivariate analysis of Cox proportional risk model showed that baseline systolic blood pressure (HR= 1.073, 95% CI: 1.018 - 1.132, P=0.009) and time averaged urinary protein excretion (TA-UPE, HR=2.123, 95% CI: 1.367-3.329, P=0.001) were the independent risk factors for prognosis of IgA nephropathy. Conclusion Various factors are correlated to the prognosis of IgA nephropathy whereas baseline systolic blood pressure and TA-UPE are the independent risk factors.
- IgA nephropathy /
- Prognosis /
- Risk factors

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图 1 IgAN的Kaplan-Meier肾生存曲线

Figure 1. Kidney survival curves of Kaplan-Meier from IgAN

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图 2 Kaplan-Meier肾生存曲线图

注：A为根据TA-UPE值所作Kaplan-Meier肾生存曲线图；B为根据SBP值所作Kaplan-Meier肾生存曲线图。

Figure 2. Graph of kidney survival with Kaplan-Meier

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表 1 163例IgA肾病患者肾活检时总体人口学及临床指标

Table 1. Demographic and clinical data of 163 patients with IgA nephropathy at renal biopsy

项目	数据
年龄[M(P₂₅, P₇₅)，岁]	33.00(28.00, 49.00)
性别(男/女，例)	82/81
BMI[M(P₂₅, P₇₅)]	23.22(20.75, 24.92)
镜检尿红细胞[M(P₂₅, P₇₅), /HP]	23.50(7.90, 60.00)
镜检尿白细胞[M(P₂₅, P₇₅), /HP]	2.90(1.00, 1.50)
UPE[M(P₂₅, P₇₅), g/d]	1.27(0.60, 2.46)
SBP[M(P₂₅, P₇₅), mm Hg]	123.00(118.00, 133.00)
DBP[M(P₂₅, P₇₅), mm Hg]	80.00(71.00, 86.50)
Hb(x±s, g/L)	130.41±19.75
SCr[M(P₂₅, P₇₅)μmol/L]	87.00(69.00, 113.00)
BUN[M(P₂₅, P₇₅), mmol/L]	5.70(4.50, 6.70)
UA(x±s, μmol/L)	356.94±100.04
eGFR[M(P₂₅, P₇₅), mL/(min·1.73 m²)]	85.50(61.75, 109.00)
ALB[M(P₂₅, P₇₅), g/L]	39.00(35.00, 42.00)
AG[M(P₂₅, P₇₅), mmol/L]	1.36(1.02, 1.80)
AC[M(P₂₅, P₇₅), mmol/L]	4.83(4.30, 5.75)
IgA(x±s, g/L)	3.26±0.95
IgG(x±s, g/L)	10.79±3.07
IgM[M(P₂₅, P₇₅), g/L]	1.05(0.74, 1.48)
肾小球硬化比例[M(P₂₅, P₇₅), %]	31.00(13.00, 52.00)
M1[例(%)]	127(77.9)
E1[例(%)]	49(30.1)
S1[例(%)]	123(75.5)
T1+T2[例(%)]	89(54.9)
C1+C2[例(%)]	72(44.2)
Lee分级4级以上[例(%)]	100(61.3)
炎症细胞浸润[例(%)]	26(16.0)
注：1 mm Hg=0.133 kPa。

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表 2 变量赋值方法

Table 2. Variable assignment method

变量	赋值
性别	男性=1, 女性=2
是否Lee分级≥4级	否=1, 是=2
结局事件	否=1, 是=2
连续变量	以实际值纳入

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表 3 IgAN进展影响因素的Cox单因素分析结果

Table 3. Cox univariate analysis of the influencing factors of IgAN progression

项目	B	SE	Wald χ²	P值	HR值	95%CI
年龄(岁)	0.009	0.032	0.080	0.777	1.009	0.947~1.075
性别	0.453	0.765	0.351	0.554	1.573	0.351~7.045
SBP(mm Hg)	0.075	0.023	10.647	0.001	1.078	1.031~1.128
DBP(mm Hg)	0.023	0.035	0.439	0.508	1.024	0.955~1.097
Hb(g/L)	-0.041	0.022	3.442	0.064	0.960	0.910~1.002
BMI	0.018	0.118	0.024	0.877	1.018	0.809~1.282
UPE(g/d)	0.325	0.123	7.008	0.008	1.384	1.088~1.760
TA-UPE(g/d)	0.640	0.204	9.795	0.002	1.896	1.270~2.830
BUN(mmol/L)	0.360	0.103	12.102	0.001	1.433	1.170~1.755
SCr(μmol/L)	0.014	0.004	10.225	0.001	1.014	1.005~1.022
UA(μmol/L)	0.006	0.004	2.012	0.156	1.006	0.998~1.014
TA-UA(μmol/L)	0.012	0.003	12.134	＜0.001	1.012	1.005~1.019
eGFR[mL/(min·1.73 m²)]	-0.081	0.023	12.242	0.007	0.942	0.902~0.983
ALB(g/L)	-0.106	0.053	3.978	0.046	0.900	0.811~0.998
TA-ALB(g/L)	-0.308	0.089	11.868	0.001	0.735	0.617~0.876
Lee分级4级以上	0.912	1.081	0.712	0.399	2.490	0.299~20.697
肾小球硬化率(%)	4.350	1.641	7.030	0.008	77.474	3.109~1 930.506
新月体比例(%)	0.006	0.143	0.002	0.966	1.112	0.760~1.333
镜检尿红细胞(/HP)	0.000	0.003	0.014	0.907	1.000	0.995~1.006
镜检尿白细胞(/HP)	-0.001	0.017	0.005	0.946	0.999	0.966~1.032

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表 4 IgAN进展影响因素的Cox多因素分析结果

Table 4. Cox multivariate analysis of the influencing factors of IgAN progression

项目	B	SE	Wald χ²	P值	HR值	95%CI
SBP(mm Hg)	0.071	0.027	6.774	0.009	1.073	1.018~1.132
TA-UPE(g/d)	0.757	0.227	11.121	0.001	2.123	1.367~3.329

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