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目的探讨伴恶性高血压的特发性IgA肾病(IgANMHT)患者的预后及影响肾存活率的相关因素。方法分析1995-01～2004-07入住南京军区南京总医院的45例IgANMHT患者的人、肾存活率,并运用Cox统计学方法分析影响IgANMHT患者进展为终末期肾功能衰竭(ESRF)的相关因素。结果IgANMHT病人、肾平均生存时间为74.9和64.7个月,5年累计人、肾存活率分别为87.1%和67.5%。Cox回归分析发现,24h尿蛋白定量≥1.5g,血肌酐(SCr)水平升高,中重度肾小球系膜增生和肾小管间质慢性化病变≥50%是其进展为ESRF的危险因素,良好的血压控制可减少其进展为ESRF的危险性。结论IgANMHT患者进展为ESRF是受多种因素影响,其中蛋白尿≥1.5g/24h、SCr水平升高是重要的危险因素。
Objective To investigate the prognosis and related factors of renal survival in idiopathic IgA nephropathy patients with malignant hypertension. Methods The survival rates of human and kidney in 45 patients with IgANMHT admitted to Nanjing General Hospital of Nanjing Military Region from January 1995 to July 2004 were analyzed and the related factors influencing the progression of IgANMHT to end-stage renal failure (ESRF) were analyzed by Cox statistical method . Results IgANMHT patients, the average survival time of kidney was 74.9 and 64.7 months, 5-year cumulative human and kidney survival rates were 87.1% and 67.5%. Cox regression analysis showed that 24h urinary protein quantitation≥1.5g, elevated serum creatinine (SCr) levels, moderate to severe mesangial hyperplasia and tubulointerstitial chronic disease≥50% were the risk factors for the progression to ESRF, Good blood pressure control can reduce the risk of progression to ESRF. Conclusion The progress of ESRF in patients with IgANMHT is influenced by many factors, of which proteinuria≥1.5g / 24h and SCr level is an important risk factor.