张勤灵
ZHANG Qinling

• 1:安徽医科大学附属阜阳医院

摘要(Abstract)：

目的:探讨抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)合并肾损伤患者预后的影响因素。方法:58例AAV合并肾损伤患者,以终末期肾病(ESRD)及死亡作为终点事件分为终点组和非终点组,比较两组部分血常规指标、白蛋白、血肌酐、血尿酸、补体(C3、C4)、血清高敏C反应蛋白、血清降钙素原、ANCA、24 h尿蛋白定量、肾小球滤过率(e GFR)、疾病活动评分(BAVS评分)、肾脏病理分型,并对两组间差异存在统计学意义的指标进行单因素及多因素Cox回归分析,探讨影响AAV预后的因素。结果:与非终点组比较,终点组患者白细胞计数、降钙素原、血肌酐、24 h尿蛋白定量、BAVS评分显著升高(P<0.05),血小板计数、高敏C反应蛋白、血沉、血白蛋白、补体C3、e GFR值显著降低(P<0.05);单因素Cox回归分析发现,血清肌酐值、补体C3以及24h尿蛋白定量是患者预后的影响因素(P<0.05);多因素Cox回归分析发现,24 h尿蛋白定量是患者预后的独立危险因素(P<0.05)。结论:血清肌酐值、补体C3水平及24 h尿蛋白定量可作为判断AAV并肾损伤患者预后的重要指标。
Objective: To investigate the prognostic factors of patients with anti-neutrophil cytoplasmic antibodies( ANCA) associated vasculitis( AAV) with renal injury. Methods: The clinical data of the patients with AAV in the General Internal Medicine of Fuyang Fourth People's Hospital and Department of Nephrology,Fuyang Hospital of Anhui Medical University from April 2014 to August 2017,were retrospectively analyzed. With end-stage renal disease( ESRD) and death as an end point,the difference from laboratory indicators,disease activity scores,renal pathological data between the groups were compared. Results: The white blood cell count,procalcitonin,creatinine,24 hour urine protein and BAVS scores in the end point group increased significantly more than those in the non-end group( P < 0. 05). The platelet count,C reactive protein,erythrocyte sedimentation rate,serum albumin,complement C3 and initial e GFR value decreased significantly( P < 0. 05). Single factor Cox regression analysis showed that the serum creatinine,complement C3 and 24 hours urine protein were the prognostic factors( P < 0. 05). Multiple factor Cox regression analysis showed that 24 hours urine protein quantitative was an independent risk factor for the prognosis of the patients( P < 0. 05).Conclusion: The serum creatinine level,complement C3 level and 24 hour urine protein level are the main factors that influence the prognosis of AAV with renal injury. Early monitoring of the levels of serum creatinine,complement C3 and 24 hour urine protein should be strengthened so as to improve prognosis and clinical treatment.

关键词(KeyWords)： 抗中性粒细胞胞浆抗体;血管炎;肾疾病;预后;肌酐;补体
anti-neutrophil cytoplasmic antibody;vasculitis;kidney disease;prognosis;creatinine;complements

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金国际合作与交流项目(81420108021);; 江苏省重点研发计划(Y0202)

作者(Author): 张勤灵
ZHANG Qinling

DOI: 10.19367/j.cnki.1000-2707.2018.08.013

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