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目的:研究老年Ig A肾病患者的临床病理相关性及影响预后的危险因素。方法:回顾性分析年龄≥60岁的原发性Ig A肾病患者的临床、病理资料及随访资料。结果:本研究共入选87例患者,平均年龄(64.9±3.9)岁。临床病理相关性分析显示,基线e GFR与牛津分型的M、T和C分别存在显著负相关关系,24 h尿蛋白定量与牛津分型的M、T和C呈正相关关系。多因素COX回归分析显示,基线e GFR(HR=0.246;95%CI 0.118~0.514)、肾小管萎缩/间质纤维化改变(HR=35.087;95%CI 1.850~665.329)、细胞性/细胞纤维性新月体形成(HR=8.061;95%CI 1.000~64.985)、细动脉透明样变性(HR=9.231;95%CI 1.900~44.836)、球性硬化比例(HR=1.033;95%CI 1.002~1.065)是老年Ig A肾病患者进展至ESRD的独立危险因素。结论:老年Ig A肾病患者的基线e GFR、与肾小管萎缩/间质纤维化、新月体形成、肾小球球性硬化、细动脉透明样变性是其进展至ESRD的危险因素。
Objective: To study the clinicopathological correlation and risk factors of prognosis in elderly patients with IgA nephropathy. Methods: The clinical, pathological and follow-up data of patients with primary IgA nephropathy aged ≥ 60 years were retrospectively analyzed. Results: A total of 87 patients were enrolled in this study, with an average age of 64.9 ± 3.9 years. Clinicopathological correlation analysis showed that there was a significant negative correlation between eGFR at baseline and M, T and C in Oxford, and a positive correlation between 24 h urinary protein and M, T and C in Oxford. Multivariate Cox regression analysis showed that baseline eGFR (HR = 0.246; 95% CI 0.118-0.514), tubular atrophy / interstitial fibrosis (HR = 35.087; 95% CI 1.850-66.5.329), and cellular / (HR = 8.061; 95% CI 1.000-64.985), degeneration of arteriole degeneration (HR = 9.231; 95% CI 1.900-44.836), percentage of sclerotic sclerosis (HR = 1.033; 95% CI 1.002 ~ 1.065) is an independent risk factor for progression to ESRD in elderly patients with IgA nephropathy. CONCLUSIONS: Baseline e GFR in elderly patients with IgA nephropathy is associated with renal tubular atrophy / interstitial fibrosis, crescent formation, glomerular sclerosis, and arteriolar hyaline degeneration as risk factors for progression to ESRD.