IgA肾病牛津病理分型与疾病进展的相关性分析

发布时间：2019-02-18 10:14

【摘要】：目的评价Ig A肾病患者肾功能损害的危险因素及牛津分型病理指标、新月体形成比例与疾病进展的相关性。方法回顾性分析深圳市第二人民医院405例Ig A肾病患者,随访时间在12个月以上。病理指标按牛津分型包括系膜细胞增生(M)、毛细血管内细胞增生(E)、节段性硬化或球囊粘连(S)、肾小管萎缩或间质纤维化(T),同时纳入细胞或细胞纤维性新月体(C)。以终末期肾脏病、肌酐翻倍或e GFR下降50%为联合终点,探讨M、E、S、T、C与疾病进展的相关性。结果(1)一般资料:405例患者中女性占48.1%,多数患者起病隐匿(80.7%),有60.5%的患者合并扁桃体肿大,平均动脉压(MAP)为99±14mm Hg,24小时尿蛋白定量为1.1(0.06-14.6)g/d,随访时间中位数为39个月,有8.2%的患者进入ESRD。(2)病理指标与临床的相关性:(1)病理指标中M1、E1、S1比例分别为85.9%,35.3%,30.9%,T1、T2比例分别为18.3%,11.1%,伴新月体形成有236例(58.3%),其中C1、C2分别占48.2%,10.1%。(2)E、S、T、C与尿蛋白水平明显相关,E、S、T与MAP明显相关,S、T、C与e GFR下降明显相关。(3)病理指标与治疗的关系显示系膜细胞增生(M)与RAS阻滞剂治疗呈正相关,与糖皮质激素与免疫抑制剂治疗无明显相关性,提示系膜(细胞)增生不是医生选择糖皮质激素及免疫抑制剂治疗的依据。内皮细胞增生(E)、局灶节段硬化(S)、间质纤维化(T)和新月体形成(C)与糖皮质激素及免疫抑制剂治疗呈正相关(E:r分别为0.223,0.254;S:r分别为0.129,0.208;T:r分别为0.173,0.291;C:r分别为0.21,0.249),其中E和S均与RAS阻滞剂治疗无明显相关,而T和C与RAS阻滞剂治疗呈负相关(r=-0.176,r=-0.105),提示内皮细胞增生、局灶节段硬化、间质纤维化和新月体形成是医生选择糖皮质激素和免疫抑制剂的重要依据,而间质纤维化程度和新月体形成常是医生谨慎使用RAS阻滞剂的依据。(3)Ig AN肾功能损害的危险因素分析结果显示,高血压、高尿酸血症、牛津分型病理指标S、T为肾功能损害的独立危险因素,而白蛋白、高密度脂蛋白可能为肾功能损害的保护性因素。(4)Kaplan-Meier生存曲线显示S、T、C与疾病进展相关,M、E与疾病进展无关,纳入单因素和多因素Cox回归后仅T为疾病进展的独立危险因素。结论(1)牛津分型病理指标间质纤维化或小管萎缩(T)对本组Ig AN的疾病进展具有独立的预测价值。(2)节段性硬化或球囊粘连(S)、新月体(C)形成比例与Ig A肾病疾病进展密切相关。(3)尿蛋白水平与牛津分型病理指标E、S、T、C具有明显相关性,MAP与病理指标E、S、T具有明显相关性,e GFR与病理指标S、T、C具有明显相关性。(4)内皮细胞增生(E)、局灶节段硬化(S)、间质纤维化(T)和新月体(C)形成是医生选择糖皮质激素和免疫抑制剂治疗Ig A肾病的重要依据;而间质纤维化程度和新月体形成常是医生谨慎使用RAS阻滞剂的依据。(5)高血压、高尿酸血症、牛津分型病理指标S、T为肾功能损害的独立危险因素,白蛋白、高密度脂蛋白是肾功能损害的保护性因素。
[Abstract]:Objective to evaluate the risk factors of renal dysfunction in patients with Ig A nephropathy and the correlation between the proportion of crescents and the progression of the disease. Methods A retrospective analysis of 405 patients with Ig A nephropathy in Shenzhen second people's Hospital was performed. The follow-up time was more than 12 months. Pathological indices according to Oxford classification include Mesangial cell proliferation, (M), intracapillary cell proliferation, (E), segmental sclerosis or balloon adhesion, (S), tubular atrophy or interstitial fibrosis (T), Inclusion of cellular or cell-fibrous crescent (C). At the same time The combined endpoints of end stage renal disease, creatinine doubling or 50% reduction of e GFR were used to investigate the correlation between MMA SMC and the progression of the disease. Results (1) General data: 48.1% of 405 patients were female, most of them had occult onset (80.7%), 60.5% had tonsillar enlargement, and the mean arterial pressure (MAP) was 99 卤14mm Hg,. The 24 hour urinary protein quantification was 1.1 (0.06-14.6) g / d, and the median follow-up time was 39 months. 8.2% of the patients entered the ESRD. (2) pathological index. The ratio of S1 to S 1 was 85.9 and 35.30.The ratio of T 1 and T 2 was 18. 3 and 11. 1, respectively. 236 cases (58.3%) were associated with crescents, of which C 1 and C 2 accounted for 48. 2%, respectively. (2) the level of urinary protein was significantly correlated with the level of Tc, and the level of MAP was significantly correlated with the level of Tc, and the level of Tc was significantly correlated with the level of urinary protein, and the level of Tc was significantly correlated with that of MAP. C and e GFR decreased significantly. (3) there was a positive correlation between Mesangial cell proliferation (M) and RAS blocker therapy, but no significant correlation with glucocorticoid and immunosuppressive therapy. The results suggest that Mesangial proliferation is not the basis for doctors to choose glucocorticoid and immunosuppressant therapy. There was a positive correlation between interstitial fibrosis (T) and crescentin formation of (E), and glucocorticoid and immunosuppressive therapy (er: r = 0.2223 0.254, respectively). S: r = 0.129 / 0.208 / T: r = 0.173 / 0.291, respectively; C: r was 0.21 / 0.249, respectively, in which E and S were not significantly correlated with RAS blockers, while T and C were negatively correlated with RAS blockers (r-0.176), suggesting endothelial cell proliferation and focal segmental sclerosis. Interstitial fibrosis and crescent formation are important evidence for doctors to select glucocorticoids and immunosuppressants. However, the degree of interstitial fibrosis and crescent formation were often the basis of careful use of RAS blockers. (3) risk factors for renal impairment in) Ig AN showed that hypertension, hyperuricemia, and Oxford classification were the pathological markers. T was an independent risk factor for renal dysfunction, while albumin and high density lipoprotein might be protective factors for renal dysfunction. (4) Kaplan-Meier survival curve showed that Kaplan-Meier was associated with the progression of the disease, but MKaplan-Meier was not associated with the progression of the disease. Only T was an independent risk factor for disease progression after univariate and multivariate Cox regression. Conclusion (1) (T) of interstitial fibrosis or tubule atrophy in Oxford classification is an independent predictor of disease progression of Ig AN. (2) segmental sclerosis or balloon adhesion (S),. The ratio of (C) formation in crescents was closely related to the progression of Ig A nephropathy. (3) the level of urinary protein was significantly correlated with the pathological index of Oxford typing, and MAP had a significant correlation with the pathological index EtoS T, and the rate of crescent formation was closely related to the progression of Ig A nephropathy. E GFR has a significant correlation with the pathological marker Scanner C. (4) (E), focal segmental sclerosis (S), of endothelial cell proliferation The formation of interstitial fibrosis (T) and crescents (C) is an important basis for doctors to select glucocorticoids and immunosuppressants in the treatment of Ig A nephropathy. However, the degree of interstitial fibrosis and crescent formation are often the basis of careful use of RAS blockers. (5) Hypertension, hyperuricemia, Oxford type pathological index SfT are the independent risk factors for renal dysfunction, albumin. High density lipoprotein is a protective factor for renal dysfunction.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.31

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