| 娄成利,王永钧.中医证型及高凝状态对特发性膜性肾病预后影响 的Logistic回归分析[J].浙江中西医结合杂志,2020,30(11): |
| 中医证型及高凝状态对特发性膜性肾病预后影响 的Logistic回归分析 |
| Effect of TCM Syndrome Type and Hypercoagulable State on Prognosis of Idiopathic Membrane Nephropathy by Logistic regression analysis |
| 投稿时间：2020-03-26 修订日期：2020-10-20 |
| DOI： |
| 中文关键词: 特发性膜性肾病 预后 血瘀证 高凝状态 Logistic |
| 英文关键词:Idiopathic membranous nephropathy, Prognosis, Blood stasis syndrome, Hypercoagulable state, Logistic |
| 基金项目:嘉兴市科技局项目（2018AD32145） |
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| 摘要点击次数: 504 |
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| 中文摘要: |
| 目的：探索中医证型、生化指标对特发性膜性肾病( idiopathic membranous nephropathy，IMN) 患者预后的影响，为患者早期评估临床疗效提供理论依据。
方法：纳入2014年11月-2016年11月于嘉兴市中医院行肾穿刺活检术证实特发性膜性肾病并正规随访3年的58例IMN患者，根据临床转归情况分为临床缓解组和临床不缓解组，临床缓解包含部分缓解和完全缓解。收集入组患者肾活检时的一般情况、临床证候、舌苔脉象、临床指标、循环抗M型磷脂酶A2受体( M-type phospholipase A2 receptor，PLA2R) 抗体等，以3年为时间截点再次收集患者各项临床指标，进行临床疗效评定。对临床缓解组、临床不缓解组的各项数据进行单因素及多因素的Logistic回归分析，得出预后相关因素的研究结果。
结果：本项研究共收集符合纳入条件的患者58例，其中临床缓解组38例（65.52%），临床不缓解组18例（31.03%），2例（3.45%）进入终点事件。比较临床缓解组和不缓解组间的临床指标发现24h尿蛋白定量、肾小球滤过率(eGFR)、血肌酐、血浆白蛋白、甘油三酯、纤维蛋白元、D-二聚体、PLA2R的差异具有统计学意义( P值＜0.05) 。中医主证中临床缓解组以脾肾气虚为主，临床不缓解组以气阴两虚为主，统计结果显示脾肾气虚型临床缓解率更高（P＜0.05），中医次证中临床缓解组以水湿证为主，临床不化解组以血瘀证为主，统计结果显示血瘀证临床不缓解率显著偏高（P＜0.05）。单因素Logistic回归显示血清白蛋白 、甘油三酯、血肌酐 、纤维蛋白原 、D-D、24hUpr、eGFR、PLA2R是IMN患者肾脏临床不良预后的危险因素。多因素Logistic回归显示PLA2R、凝血功能包括纤维蛋白原、D-D是IMN患者不良肾脏预后的独立危险因素。
结论：高凝状态是IMN患者不良肾脏预后的独立危险因素，血瘀证、外周血高凝状态包括纤维蛋白原、D-D升高提示IMN患者临床缓解率低。 |
| 英文摘要: |
| Objective: To explore the influence of TCM syndrome types and biochemical indexes on the prognosis of patients with idiopathic membranous nephropathy (IMN), and to provide theoretical basis for early evaluation of clinical efficacy of patients.Methods: A total of 58 patients with IMN who underwent renal puncture biopsy in Jiaxing Hospital of Traditional Chinese Medicine from November 2014 to November 2016 to confirm idiopathic membranous nephropathy and were regularly followed up for 3 years were divided into clinical remission groups based on clinical outcomes. In the clinical non-remission group, clinical remission included partial and complete remission. Collect the general conditions, clinical signs, tongue coating, clinical indicators, circulating anti-M-type phospholipase A2 receptor (PLA2R) antibodies before renal biopsies of patients in the group, and cut off at 3 years The patients"" clinical indicators were collected again for clinical efficacy evaluation. The data of clinical response group and clinical non-response group were analyzed by single factor and multi-factor Logistic regression, and the research results of prognostic factors were obtained.Results: A total of 58 patients eligible for inclusion were collected in this study, including 38 patients in the clinical remission group (65.52%), 18 patients in the clinical non-remission group (31.03%), and 2 patients (3.45%) entering the endpoint event. Comparison of clinical indicators between the clinical remission group and the non-remission group found that 24h urine protein quantification, glomerular filtration rate (eGFR), serum creatinine, plasma albumin, triglycerides, fibrin, D-D, PLA2R The difference was statistically significant (P value <0.05). The clinical remission group in the main syndrome of TCM is mainly spleen and kidney qi deficiency, and the clinical non-remission group is mainly qi and yin deficiency. The statistical results show that the clinical remission rate of the spleen and kidney qi deficiency type is higher (P <0.05). The group with water-dampness syndrome was the main group, and the clinical non-resolving group was mainly with blood stasis syndrome. The statistical results showed that the clinical non-remission rate of blood stasis syndrome was significantly higher (P <0.05). Univariate logistic regression showed that serum albumin, triglycerides, serum creatinine, fibrinogen, D-D, 24hUpr, eGFR, PLA2R were risk factors for poor clinical prognosis of kidney in patients with IMN. Multivariate Logistic regression showed that PLA2R, coagulation functions including fibrinogen, and D-D were independent risk factors for adverse renal prognosis in patients with IMN.Conclusion: Hypercoagulable state is an independent risk factor for adverse renal prognosis in patients with IMN. Blood stasis syndrome and peripheral blood hypercoagulable state including fibrinogen and elevated D-D suggest low clinical response rate in patients with IMN. |
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