[1]周素晗),赵 苘),张 颖),等.IgA肾病肾组织血管病变分析[J].郑州大学学报(医学版),2015,(05):686-689.
 ZHOU Suhan)),ZHAO Qing),ZHANG Ying),et al.Clinical-pathologic study of renal vascular lesions in patients with IgA nephropathy[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2015,(05):686-689.
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IgA肾病肾组织血管病变分析()
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2015年05期
页码:
686-689
栏目:
应用研究
出版日期:
2015-09-20

文章信息/Info

Title:
Clinical-pathologic study of renal vascular lesions in patients with IgA nephropathy
作者:
周素晗12)赵 苘1)张 颖1)权松霞1)邢国兰1)#
1)郑州大学第一附属医院肾脏内科 郑州 450052 2)河南省高等学校临床医学重点学科开放实验室 郑州 450052
Author(s):
ZHOU Suhan1)2)ZHAO Qing1)ZHANG Ying1)QUAN Songxia1)XING Guolan1)
1)Department of Nephrology,the First Affiliated Hospital,Zhengzhou University, Zhengzhou 450052 2)The Open Key Clinical Medical Experimental Laboratory Institute of Universities of Henan Province, Zhengzhou 450052
关键词:
IgA肾病 肾组织血管病变 预测因子
Keywords:
IgA nephropathy renal vascular lesions prognostic factor
分类号:
R692.3+1
文献标志码:
A
摘要:
目的:分析IgA肾病肾组织血管病变与临床、病理改变及预后的关系。方法:选择肾活检确诊为原发性IgA肾病的1 699例患者,观察肾血管病变发生情况,分析患者临床病理改变及预后。终点事件定义为估计的肾小球滤过率(eGFR)下降50%(排除急性肾损伤)或患者进入透析。结果:1 699例中,1 010例(59.4%)有肾组织血管病变。与无血管病变组比较,有肾组织血管病变组高血压患者比例高(χ2=49.480,P<0.001),活检时eGFR低(Z=1.720,P<0.001),系膜细胞增生患者比例、球性硬化及新月体比例高(χ2=11.478,Z=17.072、7.011,P<0.001),小管萎缩程度重(χ2=682.385,P<0.001),随访期间eGFR下降速度更快(Z=2.763,P=0.006)。随访期间,有肾组织血管病变组发生肾脏终点事件249例,无血管病变组无终点事件发生,两组生存曲线差异有统计学意义(χ2=13.196,P<0.001)。但Cox回归提示血管病变不是IgA肾病进入终点,事件的独立预测因子[HR(95%CI)=0.42(0.02~7.26)]。结论:肾组织血管病变在IgA肾病中普遍存在; 存在肾组织血管病变的IgA肾病患者临床、病理损伤程度重,预后差。
Abstract:
Aim: To estimate the value of vascular lesion for predicting renal outcomes in patients with IgA nephropathy(IgAN).Methods: A total of 1 699 cases of IgAN with renal biopsy-proven were collected to evaluate and analyze vascular lesions,clinical pathological features and renal outcomes. The primary renal endpoint was a 50% reduction in estimated glomerular filtration rate(eGFR)or end-stage renal disease.Results: A total of 1 010(59.4%)patients had vascular lesions. Compared with those of the patients without vascular lesions,at the time of renal biopsy, the patients with vascular lesions showed a higher hypertension occurence(χ2=49.480,P<0.001), lower eGFR(Z=1.720,P<0.001), a higher mesangial proliferation occurence(χ2=11.487,P<0.001),higher percentages of obsolete glomeruli and crescent(Z=17.072 and 7.011,P<0.001), more serious tubular atrophy(χ2=682.385,P<0.001),and faster eGFR descent(Z=2.763,P=0.006)during the follow-up.A total of 249 cases reached renal endpoint, and all of them were in the vascular lesions group,the Kaplan-Meier survival curve between the vasular lesion group and non-vascular lesion group had significant difference(χ2=13.196,P<0.001), but Cox model did not show that the presence of renal vascular lesions was an independent risk factor for renal outcomes[HR(95%CI)=0.42(0.02-7.26)].Conclusion:The vascular lesions is common in IgAN, and might predict serious clinical and pathological lesions, and bad renal outcomes.

参考文献/References:

[1] Donadio JV,grande JP.IgA nephropathy[J].N Engl J Med,2002,347(10):738
[2] Li LS,Liu ZH.Epidemiologic data of renal diseases from a single unit in China:analysis based on 13,519 renal biopsies[J].Kidney Int,2004,66(3):920
[3] Zhou FD,Zhao MH,Zou WZ,et al.The changing spectrum of primary glomerular diseases within 15 years: a survey of 3331 patients in a single Chinese centre[J].Nephrol Dial Transplant,2009,24(3):870
[4] Yamamoto R,Imai E.A novel classification for IgA nephropathy[J].Kidney Int,2009,76(5):477
[5] Le W,Liang S,Hu Y,et al.Long-term renal survival and related risk factors in patients with IgA nephropathy:results from a cohort of 1155 cases in a Chinese adult population[J].Nephrol Dial Transplant,2012,27(4):1479
[6] D'Amico G.Natural history of idiopathic IgA nephropathy and factors predictive of disease outcome[J].Semin Nephrol,2004,24(3):179
[7] Donadio JV,Bergstralh EJ,Grande JP,et al.Proteinuria patterns and their association with subsequent end-stage renal disease in IgA nephropathy[J].Nephrol Dial Transplant,2002,17(7):1197
[8] Wyatt RJ,Julian BA.IgA nephropathy[J].N Engl J Med,2013,368(25):2402
[9] Radford MG Jr,Donadio JV Jr,Bergstralh EJ,et al.Predicting renal outcome in IgA nephropathy[J].J Am Soc Nephrol,1997,8(2):199
[10]Goto M,Wakai K,Kawamura T,et al.A scoring system to predict renal outcome in IgA nephropathy:a nationwide 10-year prospective cohort study[J].Nephrol Dial Transplant,2009,24(10):3068
[11]Berthoux F,Mohey H,Laurent B,et al.Predicting the risk for dialysis or death in IgA nephropathy[J].J Am Soc Nephrol,2011,22(4):752
[12]Wu J,Chen X,Xie Y,et al.Characteristics and risk factors of intrarenal arterial lesions in patients with IgA nephropathy[J].Nephrol Dial Transplant,2005,20: 719
[13]Working Group of the International IgA Nephropathy Network and the Renal Pathology Society,Cattran DC,Coppo R,et al.The Oxford classification of IgA nephropathy:rationale,clinicopathological correlations,and classification[J].Kidney Int,2009,76(5):534
[14]Working Group of the International IgA Nephropathy Network and the Renal Pathology Society,Roberts IS,Cook HT,et al.The Oxford classification of IgA nephropathy:pathology definitions,correlations,and reproducibility[J].Kidney Int,2009,76(5):546
[15]Matsushita K,Mahmoodi BK,Woodward M,et al.Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate[J].JAMA,2012,307(18):1941
[16]Shi SF,Wang SX,Jiang L,et al.Pathologic predictors of renal outcome and therapeutic efficacy in IgA nephropathy:validation of the Oxford classification[J].Clin J Am Soc Nephrol,2011,6(9):2175
[17]Coppo R,Troyanov S,Bellur S,et al.Validation of the Oxford classification of IgA nephropathy in cohorts with different presentations and treatments[J].Kidney Int,2014,86(4):828
[18]Reich HN,Troyanov S,Scholey JW,et al.Remission of proteinuria improves prognosis in IgA nephropathy[J].J Am Soc Nephrol,2007,18(12):3177
[19]Suzuki H,Fan R,Zhang Z,et al.Aberrantly glycosylated IgA1 in IgA nephropathy patients is recognized by IgG antibodies with restricted heterogeneity[J].J Clin Invest,2009,119(6):1668
[20]段喜梅,张颖,刘璐,等.C3a、C5a及其受体在IgA肾病发病中的作用[J].郑州大学学报:医学版,2013,48(3):313

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更新日期/Last Update: 1900-01-01