【摘要】：目的 1.研究成人過敏性紫癜性腎炎(HSPN)的臨床、病理特點及轉(zhuǎn)歸情況。 2.霉酚酸酯聯(lián)合激素治療合并中等量蛋白尿(1.0-3.5g/24hr)的成人HSPN的病例對照研究。 方法 1.收集浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院腎臟病中心2004年1月至2013年5月期間確診為HSPN并行腎穿刺活檢的205例患者臨床、病理及治療后轉(zhuǎn)歸資料,根據(jù)不同條件分組進行回顧性分析。 2.回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院腎臟病中心2007年1月到2012年6月期間確診為HSPN并行腎穿刺活檢的63例成人HSPN患者,經(jīng)ACEI/ARB治療至少3個月后仍合并中等量蛋白尿(1.0-3.5g/24hr).分成3組；霉酚酸酯(MMF)組(21例)：加用MMF1.0-1.5g/d聯(lián)合小劑量激素(0.4-0.5mg/kg/d);激素組(27例)：加用全劑量激素(0.8-1.0mg/kg/d);對照組(15例)：繼續(xù)ACEI/ARB治療,并加至最大耐受劑量。 結(jié)果 1.205例患者平均年齡(33±16)歲,病程中均有紫癜樣皮疹,其中腹型51例(25%)、關(guān)節(jié)型38例(18.5%)。腎臟表現(xiàn)均有鏡下血尿,24小時尿蛋白總量≤1g者67例(32.7%),1.0～3.5g者93例(45.4%),≥3.5g者45例(21.9%)。估算腎小球濾過率(eGFR,簡化MDRD方程)≥90ml/min/1.73m2者151例(73.7%),60～90ml/min/1.73m2者29例(14.1％),≤60ml/min/1.73m2者25例(12.2%)。病理分級中Ⅱ級42例(20.5%),Ⅲ級147例(71.7%),Ⅳ級15例(7.3%),V級1例(0.5%)。按年齡分組比較,年齡≤18歲患者合并腹型較多(42%)；年齡≥50歲患者血沉、C反應(yīng)蛋白、IgA水平較高,eGFR水平較低,腎小球硬化比例偏高。失訪患者38例(18.5%),余167例中位隨訪時間15個月,其中完全緩解124例(60.5%),部分緩解15例(7.3%),未緩解22例(10.7%),終末期腎病6例(2.9%)。以未緩解與終末期腎病定義為治療失敗進行COX回歸分析發(fā)現(xiàn)年齡是治療失敗的獨立危險因素(P=0.011,OR=2.434)。 2.3組患者中位隨訪時間為33±17個月(6-78個月)。治療前基礎(chǔ)尿蛋白水平：MMF組2.2±0.9g/d,激素組1.9±0.8g/d,對照組1.4±0.7g/d,MMF組顯著高于對照組(p=0.007)；血清白蛋白、eGFR、腎臟病理病變程度三組間無顯著性差異。治療后MMF組和激素組蛋白尿水平顯著下降,而對照組蛋白尿水平下降不明顯。治療6個月時MMF組、激素組和對照組緩解率分別為80.9%、74.1%和46.7%。隨訪末期MMF組、激素組和對照組總緩解率分別為76.2%、70.4%和40%；隨訪期間藥物副作用的發(fā)生率：MMF組57.1%、激素組70.4%、對照組20%,其中激素組高血糖、高甘油三酯血癥等代謝異常發(fā)生率較其余兩組更高。 結(jié)論 1.老年HSPN患者疾病活動度較高,腎功能下降較明顯,治療失敗風險較高。 2.MMF聯(lián)合激素治療可有效治療合并中等量蛋白尿的成人HSPN患者,且相比于全劑量激素,藥物副作用更少。
[Abstract]:Objective 1. To study the clinical, pathological features and prognosis of (HSPN) in adult Henoch-Schonlein purpura nephritis (Henoch-Schonlein purpura). 2. A case-control study of mycophenolate mofetil combined with hormone in the treatment of adult HSPN complicated with moderate albuminuria (1.0-3.5g/24hr). Method 1. The clinical, pathological and post-treatment outcome data of 205 patients with HSPN diagnosed by the Center of Nephrology, the first affiliated Hospital of Zhejiang University Medical College from January 2004 to May 2013 were collected and analyzed retrospectively according to different conditions. 2. From January 2007 to June 2012, 63 adult HSPN patients with HSPN and renal biopsies diagnosed by the Center of Kidney Disease, the first affiliated Hospital of Medical College of Zhejiang University, were analyzed retrospectively. After treatment with ACEI/ARB for at least 3 months, moderate albuminuria (1.0-3.5g/24hr) was still complicated. Divided into three groups; Mycophenolate mofetil (MMF) group (21 cases): MMF1.0-1.5g/d combined with low dose hormone (0.4-0.5mg/kg/d), hormone group (27 cases): full dose hormone (0.8-1.0mg/kg/d); Control group (15 cases): ACEI/ARB treatment was continued and added to the maximum tolerable dose. Results the average age of 1.205 patients was (33 鹵16) years old. Purpura-like rash was found in all patients, including abdominal type in 51 cases (25%) and joint type in 38 cases (18.5%). The renal manifestations were microscopic hematuria in 67 cases (32.7%), 1.0 鈮，

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