大新月体比例对IgA肾病患者预后判断的价值

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Abstract Objective: To assess the value of large crescent in the prognosis of IgA nephropathy (IgAN). Methods: A retrospective analysis of 132 patients admitted into the First Affiliated Hospital of Wenzhou Medical University from January 2008 to February 2017 who were diagnosed by renal biopsy as primary IgAN and contained at least 1 crescents (the crescent volume accounting for more than 50% of the Bowman’s capsule, the same below) was performed. According to the proportion of glomerular crescents in the total number of glomeruli, the subjects were divided into control group with crescent proportion less than 15% and trial group with crescent proportion higher than 15%. The prognosis of the two groups was compared. Multivariate Cox proportional hazard regression analysis was used to analyze the risk factors of renal end point event (Scr doubled compared to the baseline values or had end-stage renal disease). Results: In 132 patients with IgAN, the median large crescent ratio was 8.33% (5.00%, 14.09%). The median follow-up time was 22 (12, 38) months. Compared with the control group, the average age of the patients in the trial group was older, and the level of mean arterial pressure was higher (P<0.05); the level of urinary protein and serum creatinine were higher (P<0.01); the ratio of large crescent and over moderate tubulo-interstitial lesion was higher (P<0.01). Compared with the control group, the usage rate of cytotoxic drugs in the trial group was higher, while the usage rate of RAS inhibitors was lower (P<0.05). Altogether 10 cases entered into end point events, of which 3 out of 100 were in control group, and 7 out of 32 in trail group. There was statistical differences in the incidence of end point events between the two groups (log rank χ2=21.474, P<0.001). Multiple factor stepwise Cox regression analysis results showed that the proportion of large crescents higher than 15% was an independent factor affecting the renal survival (HR=8.133, 95%CI=1.220-54.219, P<0.05). Conclusion: Large crescentic glomerular ratio above 15% may be related with negative renal outcomes of the patients with IgAN.

Key words： glomerulonephritis, IgA nephropathy renal pathology crescent prognosis

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	ZHENG Shouhao
	HUANG Zhaoxing

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2018/V48/I8/600

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