病理指标在IgA肾病预后评价中的作用研究

发布时间：2018-04-26 00:04

本文选题：IgA肾病 + 牛津分型　；参考：《浙江大学》2014年硕士论文

【摘要】：目的 IgA肾病牛津分型认为系膜细胞增生(M)、毛细血管内细胞增生(E)、节段粘连或硬化(S)、间质纤维化或肾小管萎缩(T)这四个病理指标是影响肾脏预后的独立危险因素,但未将细胞性或细胞纤维性新月体(C)纳入其中。新月体形成对IgA肾病预后的预测作用目前国际上仍有很大的争议。本研究主要验证病理指标的预后评价作用及其与临床表现之间的关联,并评估新月体是否有独立判断IgA肾病预后的价值。方法回顾性分析从2004年至2009年本中心93例IgA肾病患者,病理表现有细胞性新月体,并且随访1年以上。我们研究了肾穿时病理指标与临床表现之间的关系。根据牛津分型,病理指标包括M、E、S、T,同时我们也纳入了C。临床指标包括肾活检和随访终点的血压,蛋白尿,肌酐,肾小球滤过率,治疗用药情况。肾功能进展指标为肾功能下降速率(以eGFR斜率进行计算)和肾脏终点事件(肌酐翻倍,或eGFR下降大于50%,或进入终末期肾病)。结果经过平均47个月的随访,复合终点事件的发生率为14%。E、T、C与蛋白尿相关。E、T均与蛋白尿、平均动脉压相关。E与蛋白尿、MAP、eGFR斜率相关。E和蛋白尿大于1g/d的病人更能接受免疫抑制剂治疗。K-M生存函数显示M、E、T与肾脏存活相关,而S、C与肾脏存活无关。在单因素和多因素cox回归分析模型中,E和T仍然与终点事件相关,是影响肾脏预后的独立危险因素,M、S、C无明显相关性。结论 M、E、T均与IgA肾病预后有一定的相关性,但M不能作为判断肾脏预后的独立因素。E、T具有独立判断IgA肾病预后的价值。C与IgA肾病的预后无明显相关性,但与临床表现相关。
[Abstract]:Purpose According to Oxford Classification of IgA Nephropathy, Mesangial Cell Hyperplasia, Intelangial Cell Hyperplasia, Segmental Adhesion or Sclerosing, interstitial Fibrosis or Renal Tubular atrophy are independent risk factors for renal prognosis. However, cellular or cellulosic crescents were not included. The role of crescent formation in predicting the prognosis of IgA nephropathy is still controversial. The purpose of this study was to evaluate the prognostic value of pathological markers and their correlation with clinical manifestations, and to evaluate whether crescents have an independent prognostic value in IgA nephropathy. Method A total of 93 patients with IgA nephropathy from 2004 to 2009 were retrospectively analyzed. We studied the relationship between pathological parameters and clinical manifestations during renal puncture. According to the Oxford classification, the pathological indicators included Maue Esmus Stit, and we also included C. Clinical parameters include renal biopsy and end-point blood pressure, proteinuria, creatinine, glomerular filtration rate, and medication. The indicators of renal function progression were renal function decline rate (calculated by eGFR slope) and renal end point events (creatinine doubling, or eGFR decreasing more than 50%, or entering end-stage nephropathy). Result After an average follow-up of 47 months, the incidence of compound end point events was 14%. The mean arterial pressure correlation (.E) was associated with the slope of proteinuria MAPP eGFR. E and the patients with proteinuria larger than 1g/d were more likely to receive immunosuppressive therapy. K-M survival function showed that MMA T was associated with renal survival, but SMC was not associated with renal survival. In univariate and multivariate cox regression models, E and T were still associated with endpoint events, and there was no significant correlation between E and T as an independent risk factor for renal prognosis. Conclusion There was some correlation between the prognosis of IgA nephropathy and the prognosis of IgA nephropathy. However, M can not be used as an independent factor to judge the prognosis of IgA nephropathy. The value of IgA nephropathy. C has no significant correlation with the prognosis of IgA nephropathy, but it is related to clinical manifestations.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.31

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