Clinical outcomes of IgA nephropathy patients with different proportions of crescents
Clinical outcomes of IgA nephropathy patients with different proportions of crescents
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不同新月体比例IgA肾病患者的临床结局
DOI：
10.1097/md.0000000000006190
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发表时间：
2017-03-01
期刊：
影响因子：
1.6
通讯作者：
Yu, Xueqing
中科院分区：
文献类型：
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作者：
Zhang, Wang;Zhou, Qian;Yu, Xueqing
摘要在IgA肾病(IgAN)中，新月体累及超过50%的肾小球是肾功能迅速恶化的标志。然而，对肾小球新月体少于50%的IgAN患者的预后知之甚少。本研究旨在探讨不同比例新月体的IgAN患者的临床病理特征及预后。从2000年1月至2011年12月，组织学新月体形成的经活检证实的原发IgAN患者被纳入这项回顾性队列研究。按新月体比例分为4组：5%、5%~9%、10%~24%、≥25%。主要终点定义为基线血肌酐(SCR)和/或终末期肾病(ESRD)增加一倍，次要终点为死亡。共有538名新月征的IgAN患者接受了随访，并纳入了分析。新月体比例中位数为8.0%。新月体比例的增加与估计的肾小球滤过率(EGFR)降低、血红蛋白水平降低和尿蛋白排泄量增加相关。在中位随访期51个月(范围12-154月)后，当我们将死亡和肾脏结果合并为综合终点时，上述4组的无终点事件存活率分别为69.9%、47.7%、43.8%和40.6%(对数等级=13.7P=0.003)。校正了表皮生长因子受体、高血压、蛋白尿和牛津-MEST分级的多变量COX回归分析显示，新月比例的增加对肾脏存活率和死亡率具有预测意义(每增加5%[对数转换]：HR=1.5 1，95%CI 1.0 8-2.11，P = 0.0 2)。新月体比例较小(5%)的患者与无新月体病变患者的进一步比较显示，两组患者的预后相似。新月体比例的增加被确认为IgAN患者不良临床结局的独立预测因子。因此，在临床实践中，应更多地关注小比例的新月体，特别是5%以上的新月体。
Abstract Crescents involving more than 50% of glomeruli in IgA nephropathy (IgAN) signify a rapid deterioration of renal function. However, little is known about the prognosis of IgAN patients presenting crescents in less than 50% of glomeruli. We aimed to investigate the clinicopathological characteristics and outcomes of IgAN patients with different proportions of crescents. From January 2000 to December 2011, biopsy-proven primary IgAN patients with histological crescents formation were enrolled in this retrospective cohort study. The patients were divided into 4 groups on the basis of crescent proportion as follows: <5%, 5% to 9%, 10% to 24%, and ≥25%. The primary endpoint was defined as the doubling of baseline serum creatinine (SCr) and/or end-stage renal disease (ESRD), and the secondary endpoint was death. A total of 538 crescent-featured IgAN patients were followed up and included in the analysis. The median crescent proportion was 8.0%. An increasing crescent proportion was associated with a reduced estimated glomerular filtration rate (eGFR), decreased level of hemoglobin, and increased amount of urine protein excretion. After a median follow-up period of 51 months (range 12–154 months), the endpoint events-free survival rate of the above 4 groups were 69.9%, 47.7%, 43.8%, and 40.6%, respectively (Log rank=13.7, P= 0.003), when we incorporated death with renal outcome as a composite endpoint. Multivariate Cox regression analyses adjusting for eGFR, hypertension, proteinuria, and the Oxford-MEST classification demonstrated the predictive significance of an increasing crescent proportion with renal survival and mortality (each increase by 5% [log-transformed]: HR=1.51, 95% CI 1.08–2.11, P = 0.02). Further comparisons of patients with small proportions of crescents (<5%) and those absent of such pathological lesion showed that the 2 groups of patients had comparable prognosis. An increasing crescent proportion was identified as an independent predictor for unfavorable clinical outcomes in IgAN. Therefore, a small proportion of crescents, over 5% particularly, should be paid more attention in clinical practice.