特發(fā)性膜性腎病臨床病理特點(diǎn)及預(yù)后研究
發(fā)布時(shí)間：2019-02-15 19:54
【摘要】：目的:探討特發(fā)性膜性腎病(Idiopathic membranous nephropathy,iMN)患者臨床病理特點(diǎn),并對(duì)預(yù)后影響因素進(jìn)行分析。方法:本研究納入2010年1月至2015年3月在新疆自治區(qū)人民醫(yī)院住院并經(jīng)腎活檢診斷為iMN患者。依據(jù)估算的腎小球?yàn)V過率(Estimated glomerular filtration rate,eGFR)和尿蛋白基線水平分別分組,對(duì)臨床病理資料進(jìn)行統(tǒng)計(jì)分析;對(duì)隨訪患者按照是否達(dá)到隨訪終點(diǎn)進(jìn)行分組,繪制ROC曲線,根據(jù)ROC確定的指標(biāo)閾值進(jìn)行分組,將達(dá)到隨訪終點(diǎn)的百分率采用Kaplan Meier曲線評(píng)估,采用Cox風(fēng)險(xiǎn)比例回歸模型探討預(yù)后影響因素。結(jié)果:(1)總計(jì)241例患者入選,男性171例(70.9%),女性70例(29.1%),男、女之比約為2.4∶1,所有患者均有不同程度的蛋白尿,其中大量蛋白尿有25例(10.4%);隨訪過程中,27例(45%)患者發(fā)生尿蛋白緩解;(2)不同階段的eGFR患者組間相比,在血白蛋白(albumin,Alb)、尿β2微球蛋白(beta2-microglobulin,β2-MG)、局灶節(jié)段性腎小球硬化(focal segmental glomurular sclerosis,FSGS)及腎小管間質(zhì)損害指標(biāo)上差異均具有統(tǒng)計(jì)學(xué)意義,在血尿和腎臟小血管病變指標(biāo)上組間差異均未見統(tǒng)計(jì)學(xué)意義;(3)不同水平的24小時(shí)尿蛋白組間比較,在吸煙及eGFR指標(biāo)上差異均具有統(tǒng)計(jì)學(xué)意義;(4)多因素分析,年齡、大量蛋白尿、尿IgG、尿β2-MG及腎小管間質(zhì)損害對(duì)腎功能影響具有統(tǒng)計(jì)學(xué)意義,95%CI分別為(1.056,1.158)、(1.904,2.245)、(1.008,1.075)、(0.491,1.979)及(0.163,1.146);(5)預(yù)后影響因素分析得出尿β2-MG、尿IgG具有統(tǒng)計(jì)學(xué)意義,P值分別為0.046和0.003,95%CI分別為1.105~1.137和1.015~1.076。結(jié)論:(1)iMN以男性多見,部分患者可以發(fā)生尿蛋白緩解;(2)所有患者均有不同程度的蛋白尿,男性、吸煙、低血白蛋白濃度、病理分期高、病程較長(zhǎng)的iMN患者,尿蛋白排泄增多,腎功能下降明顯;(3)尿β2-MG、尿IgG在對(duì)疾病的預(yù)后評(píng)估上有一定的價(jià)值,并且為影響腎功能下降的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the clinicopathological features and prognostic factors of idiopathic membranous nephropathy (Idiopathic membranous nephropathy,iMN). Methods: from January 2010 to March 2015, we were hospitalized in Xinjiang people's Hospital and diagnosed as iMN by renal biopsy. According to the estimated glomerular filtration rate (Estimated glomerular filtration rate,eGFR) and the baseline level of urinary protein, the clinicopathological data were statistically analyzed. The follow-up patients were divided into groups according to whether they reached the end point of follow-up, and the ROC curve was drawn, and the percentage of the patients who reached the end of follow-up was assessed by Kaplan Meier curve according to the index threshold determined by ROC. Cox risk proportional regression model was used to study the prognostic factors. Results: (1) A total of 241 patients were enrolled, 171 males (70.9%) and 70 females (29.1%). The ratio of male to female was about 2.4: 1. There were 25 cases (10.4%) with massive proteinuria. During follow-up, urinary protein remission occurred in 27 patients (45%). (2) comparison of serum albumin (albumin,Alb), urinary 尾 2-microglobulin (beta2-microglobulin, 尾 2-MG), focal segmental glomerulosclerosis (focal segmental glomurular sclerosis,) between different stages of eGFR patients FSGS) and renal tubulointerstitial lesion were statistically significant, but there was no significant difference in hematuria and renal microvascular lesion between the two groups. (3) there were significant differences in smoking and eGFR between 24 hour urine protein groups with different levels. (4) in multivariate analysis, age, macroalbuminuria, urinary IgG, urine 尾 2-MG and renal tubulointerstitial lesion had statistically significant effects on renal function, 95%CI were 1.056 鹵1.158), (1.904), (2.245), (1.008 鹵1.075, respectively. (0.491) and (0.163) 1.146; (5) the analysis of prognostic factors showed that urinary 尾 _ 2-MG and urinary IgG had statistical significance, P = 0.046 and 0.003 ~ 95 CI = 1.105 ~ 1.137 and 1.015 ~ 1.076, respectively. Conclusion: (1) iMN is more common in men, and some patients may have urinary protein remission; (2) all patients had different degree of proteinuria, male, smoking, low serum albumin concentration, high pathological stage, long course of iMN patients, urinary protein excretion increased, renal function decreased significantly; (3) urinary 尾 2-MGand urinary IgG have certain value in evaluating the prognosis of the disease, and they are independent risk factors for the decline of renal function.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R692
[Abstract]:Objective: to investigate the clinicopathological features and prognostic factors of idiopathic membranous nephropathy (Idiopathic membranous nephropathy,iMN). Methods: from January 2010 to March 2015, we were hospitalized in Xinjiang people's Hospital and diagnosed as iMN by renal biopsy. According to the estimated glomerular filtration rate (Estimated glomerular filtration rate,eGFR) and the baseline level of urinary protein, the clinicopathological data were statistically analyzed. The follow-up patients were divided into groups according to whether they reached the end point of follow-up, and the ROC curve was drawn, and the percentage of the patients who reached the end of follow-up was assessed by Kaplan Meier curve according to the index threshold determined by ROC. Cox risk proportional regression model was used to study the prognostic factors. Results: (1) A total of 241 patients were enrolled, 171 males (70.9%) and 70 females (29.1%). The ratio of male to female was about 2.4: 1. There were 25 cases (10.4%) with massive proteinuria. During follow-up, urinary protein remission occurred in 27 patients (45%). (2) comparison of serum albumin (albumin,Alb), urinary 尾 2-microglobulin (beta2-microglobulin, 尾 2-MG), focal segmental glomerulosclerosis (focal segmental glomurular sclerosis,) between different stages of eGFR patients FSGS) and renal tubulointerstitial lesion were statistically significant, but there was no significant difference in hematuria and renal microvascular lesion between the two groups. (3) there were significant differences in smoking and eGFR between 24 hour urine protein groups with different levels. (4) in multivariate analysis, age, macroalbuminuria, urinary IgG, urine 尾 2-MG and renal tubulointerstitial lesion had statistically significant effects on renal function, 95%CI were 1.056 鹵1.158), (1.904), (2.245), (1.008 鹵1.075, respectively. (0.491) and (0.163) 1.146; (5) the analysis of prognostic factors showed that urinary 尾 _ 2-MG and urinary IgG had statistical significance, P = 0.046 and 0.003 ~ 95 CI = 1.105 ~ 1.137 and 1.015 ~ 1.076, respectively. Conclusion: (1) iMN is more common in men, and some patients may have urinary protein remission; (2) all patients had different degree of proteinuria, male, smoking, low serum albumin concentration, high pathological stage, long course of iMN patients, urinary protein excretion increased, renal function decreased significantly; (3) urinary 尾 2-MGand urinary IgG have certain value in evaluating the prognosis of the disease, and they are independent risk factors for the decline of renal function.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R692
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