205例成人过敏性紫癜性肾炎的临床特征与治疗分析

发布时间：2019-05-27 04:37

【摘要】：目的 1.研究成人过敏性紫癜性肾炎(HSPN)的临床、病理特点及转归情况。 2.霉酚酸酯联合激素治疗合并中等量蛋白尿(1.0-3.5g/24hr)的成人HSPN的病例对照研究。 方法 1.收集浙江大学医学院附属第一医院肾脏病中心2004年1月至2013年5月期间确诊为HSPN并行肾穿刺活检的205例患者临床、病理及治疗后转归资料,根据不同条件分组进行回顾性分析。 2.回顾性分析浙江大学医学院附属第一医院肾脏病中心2007年1月到2012年6月期间确诊为HSPN并行肾穿刺活检的63例成人HSPN患者,经ACEI/ARB治疗至少3个月后仍合并中等量蛋白尿(1.0-3.5g/24hr).分成3组；霉酚酸酯(MMF)组(21例)：加用MMF1.0-1.5g/d联合小剂量激素(0.4-0.5mg/kg/d);激素组(27例)：加用全剂量激素(0.8-1.0mg/kg/d);对照组(15例)：继续ACEI/ARB治疗,并加至最大耐受剂量。 结果 1.205例患者平均年龄(33±16)岁,病程中均有紫癜样皮疹,其中腹型51例(25%)、关节型38例(18.5%)。肾脏表现均有镜下血尿,24小时尿蛋白总量≤1g者67例(32.7%),1.0～3.5g者93例(45.4%),≥3.5g者45例(21.9%)。估算肾小球滤过率(eGFR,简化MDRD方程)≥90ml/min/1.73m2者151例(73.7%),60～90ml/min/1.73m2者29例(14.1％),≤60ml/min/1.73m2者25例(12.2%)。病理分级中Ⅱ级42例(20.5%),Ⅲ级147例(71.7%),Ⅳ级15例(7.3%),V级1例(0.5%)。按年龄分组比较,年龄≤18岁患者合并腹型较多(42%)；年龄≥50岁患者血沉、C反应蛋白、IgA水平较高,eGFR水平较低,肾小球硬化比例偏高。失访患者38例(18.5%),余167例中位随访时间15个月,其中完全缓解124例(60.5%),部分缓解15例(7.3%),未缓解22例(10.7%),终末期肾病6例(2.9%)。以未缓解与终末期肾病定义为治疗失败进行COX回归分析发现年龄是治疗失败的独立危险因素(P=0.011,OR=2.434)。 2.3组患者中位随访时间为33±17个月(6-78个月)。治疗前基础尿蛋白水平：MMF组2.2±0.9g/d,激素组1.9±0.8g/d,对照组1.4±0.7g/d,MMF组显著高于对照组(p=0.007)；血清白蛋白、eGFR、肾脏病理病变程度三组间无显著性差异。治疗后MMF组和激素组蛋白尿水平显著下降,而对照组蛋白尿水平下降不明显。治疗6个月时MMF组、激素组和对照组缓解率分别为80.9%、74.1%和46.7%。随访末期MMF组、激素组和对照组总缓解率分别为76.2%、70.4%和40%；随访期间药物副作用的发生率：MMF组57.1%、激素组70.4%、对照组20%,其中激素组高血糖、高甘油三酯血症等代谢异常发生率较其余两组更高。 结论 1.老年HSPN患者疾病活动度较高,肾功能下降较明显,治疗失败风险较高。 2.MMF联合激素治疗可有效治疗合并中等量蛋白尿的成人HSPN患者,且相比于全剂量激素,药物副作用更少。
[Abstract]:Objective 1. To study the clinical, pathological features and prognosis of (HSPN) in adult Henoch-Schonlein purpura nephritis (Henoch-Schonlein purpura). 2. A case-control study of mycophenolate mofetil combined with hormone in the treatment of adult HSPN complicated with moderate albuminuria (1.0-3.5g/24hr). Method 1. The clinical, pathological and post-treatment outcome data of 205 patients with HSPN diagnosed by the Center of Nephrology, the first affiliated Hospital of Zhejiang University Medical College from January 2004 to May 2013 were collected and analyzed retrospectively according to different conditions. 2. From January 2007 to June 2012, 63 adult HSPN patients with HSPN and renal biopsies diagnosed by the Center of Kidney Disease, the first affiliated Hospital of Medical College of Zhejiang University, were analyzed retrospectively. After treatment with ACEI/ARB for at least 3 months, moderate albuminuria (1.0-3.5g/24hr) was still complicated. Divided into three groups; Mycophenolate mofetil (MMF) group (21 cases): MMF1.0-1.5g/d combined with low dose hormone (0.4-0.5mg/kg/d), hormone group (27 cases): full dose hormone (0.8-1.0mg/kg/d); Control group (15 cases): ACEI/ARB treatment was continued and added to the maximum tolerable dose. Results the average age of 1.205 patients was (33 卤16) years old. Purpura-like rash was found in all patients, including abdominal type in 51 cases (25%) and joint type in 38 cases (18.5%). The renal manifestations were microscopic hematuria in 67 cases (32.7%), 1.0 鈮，

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