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目的:探讨轻度蛋白尿(24 h蛋白尿<1 g/d)IgA肾病的临床、病理特征及预后分析。方法:回顾性分析2001年~2007年在本院肾活检确诊为原发性IgA肾病且蛋白尿<1 g/d,随访时间≥6个月,终点事件定义为肌酐较基础值翻倍或eGFR下降50%或进入ESRD,进一步将患者分为蛋白尿≤0.3 g/d和蛋白尿>0.3 g/d,比较两组间患者临床、病理特征及预后情况。采用Kaplan-Meier方法进行生存分析。结果:(1)共667例患者纳入研究,男393例(58.9%),女421例(63.1%),蛋白尿中位数为0.37 g/d(0.20~0.63 g/d),血清肌酐(Scr)中位数67.0(54.9~82.2μmol/L),平均肾小球滤过率(eGFR)(107.3±33.7)ml·min-1·1.73 m-2。两组比较临床指标中Scr、eGFR等组间差异存在统计学意义(P<0.05);(2)Lee分级以Ⅲ~Ⅴ型多见,占477例(71.5%),蛋白尿≤0.3 g/d组LeeⅢ~Ⅴ级占160例(58.4%),蛋白尿>0.3 g/d组占317例(80.7%)。蛋白尿>0.3 g/d患者,其LeeⅢ~Ⅴ级的风险较蛋白尿≤0.3 g/d组增加2.51倍;(3)中位随访时间90.3(68.6,114.4)月,共40例(6.0%)进入随访终点事件。Kaplan-Meier生存分析示组间生存率差异无统计学意义(Log Rank检验χ2=2.01,f=1,P=0.156)。结论:轻度蛋白尿IgA肾病患者肾功能及病理损伤并非一定轻微,在长期随访中部分患者可出现病情加重,甚至进展至肾功能减退。进一步降低蛋白尿是一种潜在的保护效应。
Objective: To investigate the clinical, pathological features and prognosis of mild proteinuria (24 h proteinuria <1 g / d) IgA nephropathy. Methods: A retrospective analysis of 2001 ~ 2007 in our hospital renal biopsy diagnosed as primary IgA nephropathy and proteinuria <1 g / d, followed up for 6 months, the end point was defined as creatinine than the basal doubling or eGFR Decreased by 50% or entered into ESRD. Patients were further divided into proteinuria ≤0.3 g / d and proteinuria> 0.3 g / d. The clinical, pathological features and prognosis were compared between the two groups. Survival analysis was performed using the Kaplan-Meier method. Results: (1) A total of 667 patients were enrolled in the study. There were 393 (58.9%) males and 421 females (63.1%) with a median proteinuria of 0.37 g / d (0.20-0.63 g / d) and serum creatinine Scr) median of 67.0 (54.9 ~ 82.2μmol / L), mean glomerular filtration rate (eGFR) (107.3 ± 33.7) ml · min-1 · 1.73 m-2. There were significant differences between the two groups in the clinical markers of Scr and eGFR (P <0.05); (2) Lee classification was more common in type Ⅲ ~ Ⅴ, accounting for 477 cases (71.5%), proteinuria ≤0.3 g / There were 160 cases (58.4%) in Lee Ⅲ ~ Ⅴ group and 317 cases (80.7%) in 0.3g / d albuminuria group. (3) The median follow-up time was 90.3 (68.6, 114.4) months, a total of 40 cases (6.0%) had the risk of Lee Ⅲ ~ Ⅴ grade than the proteinuria ≤ 0.3 g / Enter the end of follow-up event. Kaplan-Meier survival analysis showed no significant difference between groups (Log Rank test χ2 = 2.01, f = 1, P = 0.156). Conclusion: The renal function and pathological changes of mild proteinuria in patients with IgA nephropathy are not necessarily mild. Some patients may present with aggravating disease and even renal dysfunction in long-term follow-up. Further reducing proteinuria is a potential protective effect.