IgA腎病牛津病理分型與疾病進展的相關(guān)性分析
發(fā)布時間：2019-02-18 10:14
【摘要】：目的評價Ig A腎病患者腎功能損害的危險因素及牛津分型病理指標、新月體形成比例與疾病進展的相關(guān)性。方法回顧性分析深圳市第二人民醫(yī)院405例Ig A腎病患者,隨訪時間在12個月以上。病理指標按牛津分型包括系膜細胞增生(M)、毛細血管內(nèi)細胞增生(E)、節(jié)段性硬化或球囊粘連(S)、腎小管萎縮或間質(zhì)纖維化(T),同時納入細胞或細胞纖維性新月體(C)。以終末期腎臟病、肌酐翻倍或e GFR下降50%為聯(lián)合終點,探討M、E、S、T、C與疾病進展的相關(guān)性。結(jié)果(1)一般資料:405例患者中女性占48.1%,多數(shù)患者起病隱匿(80.7%),有60.5%的患者合并扁桃體腫大,平均動脈壓(MAP)為99±14mm Hg,24小時尿蛋白定量為1.1(0.06-14.6)g/d,隨訪時間中位數(shù)為39個月,有8.2%的患者進入ESRD。(2)病理指標與臨床的相關(guān)性:(1)病理指標中M1、E1、S1比例分別為85.9%,35.3%,30.9%,T1、T2比例分別為18.3%,11.1%,伴新月體形成有236例(58.3%),其中C1、C2分別占48.2%,10.1%。(2)E、S、T、C與尿蛋白水平明顯相關(guān),E、S、T與MAP明顯相關(guān),S、T、C與e GFR下降明顯相關(guān)。(3)病理指標與治療的關(guān)系顯示系膜細胞增生(M)與RAS阻滯劑治療呈正相關(guān),與糖皮質(zhì)激素與免疫抑制劑治療無明顯相關(guān)性,提示系膜(細胞)增生不是醫(yī)生選擇糖皮質(zhì)激素及免疫抑制劑治療的依據(jù)。內(nèi)皮細胞增生(E)、局灶節(jié)段硬化(S)、間質(zhì)纖維化(T)和新月體形成(C)與糖皮質(zhì)激素及免疫抑制劑治療呈正相關(guān)(E:r分別為0.223,0.254;S:r分別為0.129,0.208;T:r分別為0.173,0.291;C:r分別為0.21,0.249),其中E和S均與RAS阻滯劑治療無明顯相關(guān),而T和C與RAS阻滯劑治療呈負相關(guān)(r=-0.176,r=-0.105),提示內(nèi)皮細胞增生、局灶節(jié)段硬化、間質(zhì)纖維化和新月體形成是醫(yī)生選擇糖皮質(zhì)激素和免疫抑制劑的重要依據(jù),而間質(zhì)纖維化程度和新月體形成常是醫(yī)生謹慎使用RAS阻滯劑的依據(jù)。(3)Ig AN腎功能損害的危險因素分析結(jié)果顯示,高血壓、高尿酸血癥、牛津分型病理指標S、T為腎功能損害的獨立危險因素,而白蛋白、高密度脂蛋白可能為腎功能損害的保護性因素。(4)Kaplan-Meier生存曲線顯示S、T、C與疾病進展相關(guān),M、E與疾病進展無關(guān),納入單因素和多因素Cox回歸后僅T為疾病進展的獨立危險因素。結(jié)論(1)牛津分型病理指標間質(zhì)纖維化或小管萎縮(T)對本組Ig AN的疾病進展具有獨立的預(yù)測價值。(2)節(jié)段性硬化或球囊粘連(S)、新月體(C)形成比例與Ig A腎病疾病進展密切相關(guān)。(3)尿蛋白水平與牛津分型病理指標E、S、T、C具有明顯相關(guān)性,MAP與病理指標E、S、T具有明顯相關(guān)性,e GFR與病理指標S、T、C具有明顯相關(guān)性。(4)內(nèi)皮細胞增生(E)、局灶節(jié)段硬化(S)、間質(zhì)纖維化(T)和新月體(C)形成是醫(yī)生選擇糖皮質(zhì)激素和免疫抑制劑治療Ig A腎病的重要依據(jù);而間質(zhì)纖維化程度和新月體形成常是醫(yī)生謹慎使用RAS阻滯劑的依據(jù)。(5)高血壓、高尿酸血癥、牛津分型病理指標S、T為腎功能損害的獨立危險因素,白蛋白、高密度脂蛋白是腎功能損害的保護性因素。
[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 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.31
本文編號：2425763
[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 鹵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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.31
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