本文選題：IgA腎病 + 牛津分型��； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的 IgA腎病牛津分型認(rèn)為系膜細(xì)胞增生(M)、毛細(xì)血管內(nèi)細(xì)胞增生(E)、節(jié)段粘連或硬化(S)、間質(zhì)纖維化或腎小管萎縮(T)這四個(gè)病理指標(biāo)是影響腎臟預(yù)后的獨(dú)立危險(xiǎn)因素,但未將細(xì)胞性或細(xì)胞纖維性新月體(C)納入其中。新月體形成對(duì)IgA腎病預(yù)后的預(yù)測作用目前國際上仍有很大的爭議。本研究主要驗(yàn)證病理指標(biāo)的預(yù)后評(píng)價(jià)作用及其與臨床表現(xiàn)之間的關(guān)聯(lián),并評(píng)估新月體是否有獨(dú)立判斷IgA腎病預(yù)后的價(jià)值。 方法 回顧性分析從2004年至2009年本中心93例IgA腎病患者,病理表現(xiàn)有細(xì)胞性新月體,并且隨訪1年以上。我們研究了腎穿時(shí)病理指標(biāo)與臨床表現(xiàn)之間的關(guān)系。根據(jù)牛津分型,病理指標(biāo)包括M、E、S、T,同時(shí)我們也納入了C。臨床指標(biāo)包括腎活檢和隨訪終點(diǎn)的血壓,蛋白尿,肌酐,腎小球?yàn)V過率,治療用藥情況。腎功能進(jìn)展指標(biāo)為腎功能下降速率(以eGFR斜率進(jìn)行計(jì)算)和腎臟終點(diǎn)事件(肌酐翻倍,或eGFR下降大于50%,或進(jìn)入終末期腎病)。 結(jié)果 經(jīng)過平均47個(gè)月的隨訪,復(fù)合終點(diǎn)事件的發(fā)生率為14%。E、T、C與蛋白尿相關(guān)。E、T均與蛋白尿、平均動(dòng)脈壓相關(guān)。E與蛋白尿、MAP、eGFR斜率相關(guān)。E和蛋白尿大于1g/d的病人更能接受免疫抑制劑治療。K-M生存函數(shù)顯示M、E、T與腎臟存活相關(guān),而S、C與腎臟存活無關(guān)。在單因素和多因素cox回歸分析模型中,E和T仍然與終點(diǎn)事件相關(guān),是影響腎臟預(yù)后的獨(dú)立危險(xiǎn)因素,M、S、C無明顯相關(guān)性。 結(jié)論 M、E、T均與IgA腎病預(yù)后有一定的相關(guān)性,但M不能作為判斷腎臟預(yù)后的獨(dú)立因素。E、T具有獨(dú)立判斷IgA腎病預(yù)后的價(jià)值。C與IgA腎病的預(yù)后無明顯相關(guān)性,但與臨床表現(xiàn)相關(guān)。
[Abstract]:Purpose According to Oxford Classification of IgA Nephropathy, Mesangial Cell Hyperplasia, Intelangial Cell Hyperplasia, Segmental Adhesion or Sclerosing, interstitial Fibrosis or Renal Tubular atrophy are independent risk factors for renal prognosis. However, cellular or cellulosic crescents were not included. The role of crescent formation in predicting the prognosis of IgA nephropathy is still controversial. The purpose of this study was to evaluate the prognostic value of pathological markers and their correlation with clinical manifestations, and to evaluate whether crescents have an independent prognostic value in IgA nephropathy. Method A total of 93 patients with IgA nephropathy from 2004 to 2009 were retrospectively analyzed. We studied the relationship between pathological parameters and clinical manifestations during renal puncture. According to the Oxford classification, the pathological indicators included Maue Esmus Stit, and we also included C. Clinical parameters include renal biopsy and end-point blood pressure, proteinuria, creatinine, glomerular filtration rate, and medication. The indicators of renal function progression were renal function decline rate (calculated by eGFR slope) and renal end point events (creatinine doubling, or eGFR decreasing more than 50%, or entering end-stage nephropathy). Result After an average follow-up of 47 months, the incidence of compound end point events was 14%. The mean arterial pressure correlation (.E) was associated with the slope of proteinuria MAPP eGFR. E and the patients with proteinuria larger than 1g/d were more likely to receive immunosuppressive therapy. K-M survival function showed that MMA T was associated with renal survival, but SMC was not associated with renal survival. In univariate and multivariate cox regression models, E and T were still associated with endpoint events, and there was no significant correlation between E and T as an independent risk factor for renal prognosis. Conclusion There was some correlation between the prognosis of IgA nephropathy and the prognosis of IgA nephropathy. However, M can not be used as an independent factor to judge the prognosis of IgA nephropathy. The value of IgA nephropathy. C has no significant correlation with the prognosis of IgA nephropathy, but it is related to clinical manifestations.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.31

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相關(guān)期刊論文 前2條

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本文編號(hào)：1803568