CAJ | 학술논문

目的研究成人过敏性紫癜性肾炎(HSPN)的临床、病理特点及转归情况.方法收集本中心2004年1月至2013年5月期间确诊为HSPN并行肾穿刺活检的205例患者临床、病理及治疗后转归资料,根据不同条件分组进行回顾性分析.结果患者平均年龄(33±16)岁,病程中均有紫癜样皮疹,其中腹型51例(25％)、关节型38例(18.5％).肾脏表现均有镜下血尿,尿蛋白总量≤1 g/24 h者67例(32.7％),1.0 ～ 3.5 g/24 h者93例(45.4％),≥3.5 g/24 h者45例(21.9％).肾小球滤过率(eGFR)≥90 ml·min-1·(1.73 m2)-1者151例(73.7％),61～89ml·min-1·(1.73 m2)-1者29例(14.1％),≤60 ml· min-1·(1.73 m2)-1者25例(12.2％).肾脏病理分级中Ⅱ级42例(20.5％),Ⅲ级147例(71.7％),Ⅳ级15例(7.3％),V级1例(0.5％).按年龄分组比较,年龄≤18岁患者合并腹型较多(42％);年龄≥50岁患者血沉、C反应蛋白、IgA水平较高,eGFR水平较低,肾小球硬化比例较高.失访患者38例(18.5％),余167例中位随访时间15个月,其中完全缓解124例(60.5％),部分缓解15例(7.3％),未缓解22例(10.7％),终末期肾病6例(2.9％).以未缓解与终末期肾病定义为治疗失败进行Cox回归分析发现年龄是治疗失败的独立危险因素(OR=2.434,P=0.011).结论老年HSPN患者疾病活动度较高,肾功能下降较明显,治疗失败风险较高.
목적 연구성인과민성자전성신염(HSPN)적림상、병리특점급전귀정황.방법 수집본중심2004년1월지2013년5월기간학진위HSPN병행신천자활검적205례환자림상、병리급치료후전귀자료,근거불동조건분조진행회고성분석.결과 환자평균년령(33±16)세,병정중균유자전양피진,기중복형51례(25％)、관절형38례(18.5％).신장표현균유경하혈뇨,뇨단백총량≤1 g/24 h자67례(32.7％),1.0 ～ 3.5 g/24 h자93례(45.4％),≥3.5 g/24 h자45례(21.9％).신소구려과솔(eGFR)≥90 ml·min-1·(1.73 m2)-1자151례(73.7％),61～89ml·min-1·(1.73 m2)-1자29례(14.1％),≤60 ml· min-1·(1.73 m2)-1자25례(12.2％).신장병리분급중Ⅱ급42례(20.5％),Ⅲ급147례(71.7％),Ⅳ급15례(7.3％),V급1례(0.5％).안년령분조비교,년령≤18세환자합병복형교다(42％);년령≥50세환자혈침、C반응단백、IgA수평교고,eGFR수평교저,신소구경화비례교고.실방환자38례(18.5％),여167례중위수방시간15개월,기중완전완해124례(60.5％),부분완해15례(7.3％),미완해22례(10.7％),종말기신병6례(2.9％).이미완해여종말기신병정의위치료실패진행Cox회귀분석발현년령시치료실패적독립위험인소(OR=2.434,P=0.011).결론 노년HSPN환자질병활동도교고,신공능하강교명현,치료실패풍험교고.
Objective To analyze the clinical,pathological data and outcomes of the adult patients with Henoch-Sch(o)nlein purpura nephritis (HSPN).Methods The data of 205 HSPN patients who were diagnosed in Kidney Disease Center of the First Affiliated Hospital of Zhejiang University between Jan 2004 and May 2013 were collected and analyzed in different groups.Results The average age of the patients was (33± 16) years old.All patients had purpura,25％ patients had abdominal symptoms and arthritis was reported in 18.5％ patients.All patients reported hematuria; 32.7％ patients were with urine protein less than 1 g/24 h and 21.9％ patients had urine protein more than 3.5 g/24 h; 73.7％ patients had normal level of glomerular filtration rate (eGFR,calculated by simplified MDRD equation); 14.1％ patients had mild renal insufficiency [eGFR 60～ 90 ml· min-1 ·(1.73 m2)-1] and 12.2％ patients were with eGFR less than 60 ml· min-1 · (1.73 m2)-1.The type Ⅱ renal pathological changes were reported in 20.5％ patients,71.7％ patients were with type Ⅲ,7.3％ patients were with type Ⅳ and only one patient had type V pathological changes.The patients younger than 18 years had more abdominal involvement; the patients older than 50 years had higher levels of ESR,serum C reactive protein,serum IgA and more proportion of glomerular sclerosis,but lower eGFR level.Thirty-eight patients (18.5％) were lost follow up.The median follow-up of the other 167 patients was 15 months.The complete remission was reported in 124 patients (60.5％) and partial remission were reported in 15 patients (7.3％); 22 cases were unrelieved and 6 cases exhibited end stage renal disease (ESRD).The COX regression analysis revealed that old age was the independent risk factor of no relief and ESRD (P =0.011,OR =2.434).Conclusion The elderly HSPN patients has higher disease activity,more obvious decline in renal function and higher risk of treatment failure.