成人特发性局灶节段硬化性肾小球肾炎患者eGFR分期与相关因素分析

发布时间：2018-06-22 04:03

本文选题：局灶节段硬化性肾小球肾炎 + 估算的肾小球率过滤　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：探讨成人特发性局灶节段硬化性肾小球肾炎(FSGS)患者预估的肾小球率过滤(eGFR)分期与相关指标的相关分析。方法:局灶节段硬化性肾小球肾炎81例,按eGFR漫性肾脏病分期分3组：慢性肾脏病1期eGFR90ml/min慢性肾脏病2期90ml/mineGFR60ml/min'慢性肾脏病3期60ml/mineGFR30ml/min。比较eGFR各期的血压、肌酐、尿素氮、胱抑素、血色素、尿酸、尿微量白蛋白、胱抑素、PTH、血清钙、磷、总胆固醇、甘油三酯等相关因素的组间差异及各组相关指标与50名当地体检健康人群的差异。结果：81例成人特发性FSGS平均年龄为(38.91±11.964)岁,男女比例：1.07：1,82.72%的患者合并蛋白尿,其中大量蛋白尿(24小时尿蛋白定量3.5g/l)占27.10%,血尿(红细胞计数1万/m1)占80.25%,49.38%的FSGS患者合并高血压,是否合并大量蛋白尿、血尿、高血压在FSGS患者eGFR分期中有统计学意义(P0.05),尿酸、胱抑素、肌酐、尿素氮随着eGFR的进展呈上升趋势(P0.05),血红蛋白呈下降趋势(P0.05),体重指数、总胆固醇、甲状旁腺素、血清钙、血清磷、血清白蛋白、血清总蛋白在FSGS患者eGFR1-3期各期之间未有统计学意义(P0.05)。胱抑素、尿微量白蛋白在eGFR1期与当地健康体检人群有差异(P0.05),尿酸、尿素氮、肌酐于eGFR2期与新疆体检健康人群有差异(p0.05),甘油三酯、血红蛋白、血清钙离子、甲状旁腺素3期与新疆体检健康人群的有统计学意义(P0.05)。其中血红蛋白,肌酐,尿酸是加重FSGS患者eGFR1期到2期的独立危险因素P值分别为0.018,0.003,0.031。其余指标未有统计学意义。结论：①原发性FSGS好发于中青年,男性多见,起病隐匿；②临床上蛋白尿最为常见,其次是血尿,3.合并高血压、血尿、大量蛋白尿的FSGS患者eGFR进展更快,肌酐、尿素氮、尿酸异常发生在eGFR2期,血红蛋白、甘油三酯、血清钙离子、甲状旁腺素异常发生在eGFR3期,尿微量白蛋白、胱抑素在eGFR1期即出现异常改变,以上指标,通过对FSGS患者相关代谢及并发症发生时间的研究,可对eGFR各期有针对性的进行治疗,早期诊断筛查,早治疗,明确加速FSGS患者eGFR进展的多种危险因素,从而对预后的评估、治疗方案的制定等方面提出建设性意见。
[Abstract]:Objective: to investigate the correlation between glomerular rate filtration (eGFR) stage and related indexes in adult patients with focal segmental sclerosing glomerulonephritis (FSGS). Methods: 81 cases of focal segmental sclerosing glomerulonephritis were divided into 3 groups according to eGFR diffuse kidney disease stage 1: chronic kidney disease stage 1, eGFR 90 ml / min, chronic kidney disease stage 2, chronic glomerulonephritis 60 ml / min, chronic kidney disease stage 3 60 ml / r mineGFR 30 ml / min. Blood pressure, creatinine, urea nitrogen, cystatin, hemoglobin, uric acid, urinary microalbumin, cystatin, serum calcium, phosphorus, total cholesterol, The difference of relative factors such as triglyceride between groups and 50 healthy people. Results the average age of 81 adult patients with idiopathic FSGs was (38.91 卤11.964) years old. The ratio of male to female was 1.07: 1, 82.72% of the patients had proteinuria. The patients with massive proteinuria (24-hour urinary protein quantitative 3.5g/l) accounted for 27.10 0%, and hematuria (RBC 10 000 / ml) accounted for 80.2549.38% of FSGS patients with hypertension. There was a significant difference in the eGFR stage of FSGS patients (P0.05). Uric acid, cystatin, creatinine, urea nitrogen increased with the progress of eGFR (P0.05), hemoglobin decreased (P0.05), body mass index (BMI), total cholesterol. The levels of parathyroid hormone, serum calcium, serum phosphorus, serum albumin and serum total protein were not significantly different between the stages of eGFR1-3 stage of FSGS (P0.05). There were significant differences in cystatin, urinary microalbumin between eGFR1 and local healthy people (P0.05), uric acid, urea nitrogen, creatinine in eGFR2 phase and Xinjiang healthy population (p0.05), triglyceride, hemoglobin, serum calcium, Parathyroid hormone stage 3 and healthy people in Xinjiang had statistical significance (P0.05). Among them, hemoglobin, creatinine and uric acid were independent risk factors (P = 0.018 卤0.003, P = 0.031) for eGFR1 to EGFR2 exacerbations in patients with FSGS. The other indicators were not statistically significant. Conclusion the primary FSGS is more common in middle and young men, and occult proteinuria is the most common in clinic, followed by hematuria 3. In FSGS patients with hypertension, hematuria, and proteinuria, the eGFR progression was faster. The abnormality of creatinine, urea nitrogen and uric acid occurred in eGFR2, hemoglobin, triglyceride, serum calcium ion, abnormal parathyroid hormone in eGFR3, urinary albumin. The changes of cystatin in eGFR1 phase were abnormal. By studying the related metabolism and the time of complications in patients with FSGS, we can treat eGFR in different stages, early diagnosis and screening, and early treatment. To identify the risk factors to accelerate the progression of eGFR in patients with FSGS, and to make constructive suggestions on the evaluation of prognosis and the formulation of treatment plan.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.6

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