作　　者： (程一春）; (葛树旺）; (骆冉）; (杨毅）; (郭水明）; (徐钢）;

机构地区： 华中科技大学同济医学院附属同济医院,武汉430030

出　　处： 《内科急危重症杂志》 2017年第4期272-274,321,共4页

摘　　要： 目的:探讨影响IgA肾病患者预后的危险因素。方法:选取诊断为IgA肾病患者622例的基本资料,肾脏终点为患者肾小球过率(eGFR)下降50%或发生终末期肾病(ESRD)。采用Kaplan-Meier方法计算生存率,使用单因素及多因素COX回归分析影响IgA肾病患者预后的危险因素。结果:全部患者1年、3年、5年肾脏生存率分别为99.6%,98.4%,91.9%。多因素COX回归分析结果显示患者肾活检时慢性肾脏病(CKD)分期(HR:4.79,95%CI:1.25~18.36,P=0.022)、24 h尿蛋白定量(HR:5.08,95%CI:1.04~24.83,P=0.045)和血清补体C3(HR:0.01,95%CI:0.01~0.59,P=0.016)是IgA患者疾病进展的独立危险因素。结论:8.1%的IgA肾病患者在5年之内eGFR下降50%或进展为ESRD,肾活检时肾功能不全、高24 h尿蛋白定量以及低血清补体C3是预后的独立危险因素。 Objective： To identify the risk factors of poor outcome in patients with IgA nephropathy by retrospective cohort study. Methods： We enrolled 622 patients who were diagnosed as IgA nephropathy by renal biopsies and followed up regularly. All baseline clinical data were recorded and regular follow-up was performed. The survival rate was calculated by Kaplan-Meier method and risk factors were evaluated by univariate and multivariate COX proportional-hazards regression. Results： The 1-,3-and 5-year cumulative renal survival rate was 99. 6%,98. 4% and 91. 9% respectively. Multivariate COX analysis showed that CKD stages（ HR： 4. 79,95% CI： 1. 25-18. 36,P = 0. 022）,24 h protein excretion（ HR： 5. 08,95% CI： 1. 04-24. 83,P = 0. 045） and serum C3（ HR： 0. 01,95% CI： 0. 010. 59,P = 0. 016） were significantly independent risk factors. Conclusion： 8. 1% patients of IgA nephropathy have 50% decrease in eGFR or progress to end stage renal disease within 5 years. Three clinical features-impaired renal function,higher proteinuria and lower serum C3-are independent predictors of poor outcome in patients with IgA nephropathy.

关 键 词： 肾病 危险因素 预后