切换至 "中华医学电子期刊资源库"
高级检索
中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 28 -33. doi: 10.3877/cma.j.issn.2095-3216.2018.01.007

所属专题： 文献；

论著

成人微小病变肾病综合征发生急性肾损伤的相关影响因素分析
杨琛1, 蔡广研,1, 陈仆1, 孟金铃1, 吴杰1, 张雪光1, 王涌1, 刘述文1, 吴镝1, 陈香美1   
  1. 1. 100853　北京，解放军总医院肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心
  • 收稿日期:2017-11-19 出版日期:2018-02-28
  • 通信作者: 蔡广研
  • 基金资助:
    国家科技支撑计划课题(2015BAI12B06)

Analysis of related factors of acute kidney injury in adult minimal change nephrotic syndrome

Chen Yang1, Guangyan Cai,1, Pu Chen1, Jinling Meng1, Jie Wu1, Xueguang Zhang1, Yong Wang1, Shuwen Liu1, Di Wu1, Xiangmei Chen1   

  1. 1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Chronic Kidney Diseases, Beijing 100853, China
  • Received:2017-11-19 Published:2018-02-28
  • Corresponding author: Guangyan Cai
  • About author:
    Corresponding author: Cai Guangyan, Email:
全文 ( 0 ) 下载PDF ( 0 ) 导出引用
引用本文：

杨琛, 蔡广研, 陈仆, 孟金铃, 吴杰, 张雪光, 王涌, 刘述文, 吴镝, 陈香美. 成人微小病变肾病综合征发生急性肾损伤的相关影响因素分析[J/OL]. 中华肾病研究电子杂志, 2018, 07(01): 28-33.

Chen Yang, Guangyan Cai, Pu Chen, Jinling Meng, Jie Wu, Xueguang Zhang, Yong Wang, Shuwen Liu, Di Wu, Xiangmei Chen. Analysis of related factors of acute kidney injury in adult minimal change nephrotic syndrome[J/OL]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(01): 28-33.

目的

探讨成人微小病变肾病综合征发生急性肾损伤( AKI)的相关影响因素。

方法

回顾性分析2002年1月1日至2015年12月31日在解放军总医院病理诊断为微小病变肾病，临床表现为首发肾病综合征的成年患者。记录其横断面临床及病理指标，并将其分为AKI组及非AKI组进行比较。用单因素及多元Logistic回归分析与AKI发生相关的影响因素。并对AKI相关的各影响因素进行交互作用检验。

结果

共纳入403例患者，男女比例为1∶1.13，肾活检时平均年龄为(39.5 ± 15.1)岁，其中118(29.3%)例发生了AKI。AKI组与非AKI组相比，年龄、性别、尿蛋白定量、血清白蛋白、血肌酐、血尿素氮、估算的肾小球率过滤、肾小管萎缩、肾间质病变差异均有统计学意义(P<0.05)。单因素Logistic回归分析显示高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病发生AKI的危险因素。交互作用检验表明血清白蛋白对AKI的作用受到肾间质纤维化的显著影响(P＝0.0 050)，且在调整年龄分组、性别、高血压、尿蛋白定量、肾小管萎缩、肾间质水肿、肾间质炎细胞浸润混杂因素后，其交互作用仍显著(P＝0.0 263)。从多元Logistic回归分析可见，在无肾间质纤维化的人群中，血清白蛋白水平的升高是AKI的独立保护因素(调整后的OR 0.8，95%CI 0.7～ 0.9，P<0.001)。在有肾间质纤维化人群中，血清白蛋白的升高对AKI肾脏的保护作用不显著(调整后的OR 1.0，95%CI 0.9～1.0，P＝0.0 278)。

结论

高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病综合征发生AKI的危险因素。血清白蛋白升高对AKI的保护作用受到肾间质纤维化的影响。

关键词: 急性肾损伤, 成人, 微小病变肾病, 肾病综合征, 血清白蛋白
Objective

To investigate the related factors of acute kidney injury (AKI) in adult minimal change disease (MCD).

Methods

A retrospective analysis was made in the patients (>18 years old) with first-presented nephrotic syndrome and biopsy-proven MCD from January 1, 2002 to December 31, 2015. The patients were divided into two groups: the AKI group and the non-AKI group. Univariate and multivariate logistic regression were used to analyze the influencing factors associated with the occurrence of AKI. And the interaction of AKI related factors was tested.

Results

A total of 403 patients were included. The ratio between males and females was 1∶1.13. The average age at renal biopsy was 39.5 ± 15.1 years. AKI occurred in 118 cases (29.3%) of the 403 patients. The AKI group had statistically significant differences in age, gender, urinary protein quantification, serum albumin, serum creatinine, blood urea nitrogen, estimated glomerular filtration rate (eGFR), tubular atrophy, and renal interstitial lesions compared with the non-AKI group (P<0.05). Univariate logistic regression analysis showed that the elderly age, maleness, higher urinary protein, tubular atrophy, renal interstitial edema, interstitial fibrosis, inflammatory cell infiltration, and hypertension were the risk factors for the occurrence of AKI in adult MCD. Interaction tests showed that the effect of serum albumin on AKI was significantly affected by renal interstitial fibrosis (P=0.005), and this interaction was still significant after adjustment of such factors as age group, gender, hypertension, urinary protein quantification, tubular atrophy, renal interstitial edema, and renal interstitial cell infiltration (P=0.0 263). In the non-interstitial fibrosis patients, serum albumin increase was an independent protective factor for AKI (adjusted OR, 0.8; 95%CI, 0.7-0.9, P<0.001). In the interstitial fibrosis patients, the influence of serum albumin increase on AKI was not significant (adjusted OR 1.0, 95%CI, 0.9- 1.0, P=0.0 278).

Conclusion

Elderly age, maleness, higher proteinuria, renal tubular atrophy, renal interstitial edema, renal interstitial fibrosis, inflammatory cell infiltration, and hypertension, were risk factors for the occurrence of AKI in adult MCD. The protective effect of serum albumin increase on AKI was influenced by the renal interstitial fibrosis.

Key words: Acute kidney injury, Adult, Minimal change disease, Nephrotic syndrome, Serum albumin
图1 成人微小病变肾病综合征发生急性肾损伤病例筛选流程
表1 成人微小病变肾病综合征研究人群临床及病理特点
? 非AKI组 AKI组 检验值 P值
总例数 284 118 ? ?
年龄(岁) 37.6 ± 13.5 44.1 ± 17.8 4.028 0.001
男性[例(%)] 107 (37.7 ) 82 (69.5 ) 33.873 <0.001
血清白蛋白(g/L) 21.0 ± 5.1 18.9 ± 4.4 3.899 <0.001
尿蛋白定量(g/d) 5.5 ± 3.3 6.5 ± 3.4 2.746 0.007
血尿素氮(mmol/L) 5.3 ± 2.5 10.7 ± 6.3 12.427 <0.001
血肌酐(μmol/L) 70.4 ± 18.9 148.2 ± 96.3 13.037 <0.001
eGFR[ml/(min·1.73 m2)] 104.7 ± 19.8 62.1 ± 30.4 16.604 <0.001
血红蛋白(g/L) 142.9 ± 18.7 142.6 ± 21.0 0.124 0.953
肾小管蛋白管型[例(%)] 118 (41.5 ) 60 (50.8 ) 2.921 0.087
肾小管萎缩[例(%)] 97 (34.2 ) 61 (51.7 ) 10.751 0.001
肾间质水肿[例(%)] 39 (13.9 ) 28 (23.7 ) 5.770 0.016
肾间质炎细胞浸润[例(%)] 87 (30.6 ) 67 (56.8 ) 24.114 <0.001
肾间质纤维化[例(%)] 107 (37.7 ) 63 (53.4 ) 8.434 0.004
肾小动脉透明样变性[例(%)] 27 (9.5 ) 16 (13.6 ) 1.433 0.231
肾小动脉内膜增厚[例(%)] 74 (26.1 ) 35 (29.7 ) 0.548 0.459
合并高血压[例(%)] 27 (9.5 ) 48 (40.7 ) 53.372 <0.001
合并糖尿病[例(%)] 6 (2.1 ) 4 (3.4 ) 0.560 0.454
表2 成人微小病变肾病综合征AKI发生相关危险因素的单因素Logistic回归分析
? OR (95%CI) P值
起病时年龄(岁) 1.0 (1.0～ 1.0) <0.001
年龄分组 ? ?
? 青年(<45岁) 参考 ?
? 中年(≥45岁) 1.7 (1.0～ 2.8) 0.045
? 老年(≥60岁) 3.7 (1.9～ 7.2) <0.001
男性(比女性) 3.8 (2.4～6.0) <0.001
血清白蛋白(g/L) 0.9 (0.9～1.0) <0.001
尿蛋白定量(g/d) 1.1 (1.0～1.2) 0.007
血尿素氮(mmol/L) 1.4 (1.3～1.5) <0.001
血肌酐(μmol/L) 1.1 (1.1～ 1.1) <0.001
eGFR[ml/(min·1.73 m2)] 0.9 (0.9～1.0) <0.001
血红蛋白(g/L) 1.0 (1.0～1.0) 0.901
肾小管萎缩(%) 2.1 (1.3～3.2) 0.001
蛋白管型(%) 1.5 (0.9～ 2.2) 0.088
肾间质水肿(%) 2.0 (1.1～ 3.4) 0.015
肾间质炎细胞浸润(%) 3.0 (1.9～4.6) <0.001
肾间质纤维化(%) 1.9 (1.2～2.9) 0.004
肾小动脉内膜增厚(%) 1.2 (0.7～ 1.9) 0.459
肾小动脉透明样变性(%) 1.5 (0.8～ 2.9) 0.234
合并高血压(%) 6.5 (3.8～11.2) <0.001
合并糖尿病(%) 1.6 (0.5～ 5.9) 0.458
图2 成人微小病变肾病综合征患者血清白蛋白水平与急性肾损伤发生风险的平滑曲线拟合
图3 在有或无肾间质纤维化的不同人群中，血清白蛋白水平与急性肾损伤发生风险的平滑曲线拟合
表3 血清白蛋白与AKI的发生风险在成人微小病变肾病综合征不同人群当中的多元Logistic回归关系
? 例数 无调整 模型Ⅰ 模型Ⅱ
OR(95%CI) P值 OR(95%CI) P值 OR(95%CI) P值
无肾间质纤维化 233 0.8 (0.8～ 0.9) <0.001 0.8 (0.7～ 0.9) <0.001 0.8 (0.7～ 0.9) <0.001
有肾间质纤维化 170 1.0 (0.9～1.0) 0.188 0.9 (0.9～ 1.0) 0.139 1.0 (0.9～1.0) 0.245
总体 403 0.9 (0.9～1.0) <0.001 0.9 (0.8～0.9) <0.001 0.9 (0.8～1.0) 0.001
交互作用检验a - - 0.0050 - 0.0197 - 0.0263
[1]
Vivarelli M, Massella L, Ruggiero B, et al. Minimal change disease [J]. Clin J Am Soc Nephrol, 2017, 12(2): 332-345.
[2]
Imtiaz S, Drohlia MF, Nasir K, et al. Analysis of renal diseases detected in renal biopsies of adult patients: a single-center experience [J]. Saudi J Kidney Dis Transpl, 2017, 28(2): 368-378.
[3]
Chang JH, Kim DK, Kim HW, et al. Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience [J]. Nephrol Dial Transplant, 2009, 24(8): 2406-2410.
[4]
李敏侠，蔡广研. 老年肾病综合征的诊治[J]. 中国实用内科杂志，2014, 34(12): 1138-1141.
[5]
Komukai D, Hasegawa T, Kaneshima N, et al. Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study [J]. Nephrology (Carlton), 2016, 21(10): 887-892.
[6]
Maas RJ, Deegens JK, Beukhof JR, et al. The clinical course of minimal change nephrotic syndrome with onset in adulthood or late adolescence: a case series [J]. Am J Kidney Dis, 2017, 69(5): 637-646.
[7]
Szeto CC, Lai FM, Chow KM, et al. Long-term outcome of biopsy-proven minimal change nephropathy in Chinese adults [J]. Am J Kidney Dis, 2015, 65(5): 710-718.
[8]
Dias CB, Pinheiro CC, Silva Vdos S, et al. Proteinuria predicts relapse in adolescent and adult minimal change disease [J]. Clinics (Sao Paulo), 2012, 67(11): 1271-1274.
[9]
Waldman M, Crew RJ, Valeri A, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes [J]. Clin J Am Soc Nephrol, 2007, 2(3): 445-453.
[10]
Huang JJ, Hsu SC, Chen FF, et al. Adult-onset minimal change disease among Taiwanese: clinical features, therapeutic response, and prognosis [J]. Am J Nephrol, 2001, 21(1): 28-34.
[11]
Yang L, Xing G, Wang L, et al. Acute kidney injury in China: a cross-sectional survey [J]. Lancet, 2015, 386(10002): 1465-1471.
[12]
Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C [J]. N Engl J Med, 2012, 367(1): 20-29.
[13]
Chen T, Lv Y, Lin F, et al. Acute kidney injury in adult idiopathic nephrotic syndrome [J]. Ren Fail, 2011, 33(2): 144-149.
[14]
Cameron JS. The nephrotic syndrome and its complications [J]. Am J Kidney Dis, 1987, 10(3): 157-171.
[15]
Jennette JC, Falk RJ. Adult minimal change glomerulopathy with acute renal failure [J]. Am J Kidney Dis, 1990, 16(5): 432-437.
[16]
Coca SG. Acute kidney injury in elderly persons [J]. Am J Kidney Dis, 2010, 56(1): 122-131.
[17]
Liu WJ, Xu BH, Ye L, et al. Urinary proteins induce lysosomal membrane permeabilization and lysosomal dysfunction in renal tubular epithelial cells [J]. Am J Physiol Renal Physiol, 2015, 308(6): F639-F649.
[18]
Fujigaki Y, Tamura Y, Nagura M, et al. Unique proximal tubular cell injury and the development of acute kidney injury in adult patients with minimal change nephrotic syndrome [J]. BMC Nephrol, 2017, 18(1): 339.
[19]
Zoja C, Abbate M, Remuzzi G. Progression of renal injury toward interstitial inflammation and glomerular sclerosis is dependent on abnormal protein filtration [J]. Nephrol Dial Transplant, 2015, 30(5): 706-712.
[20]
Lowenstein J, Schacht RG, Baldwin DS. Renal failure in minimal change nephrotic syndrome [J]. Am J Med, 1981, 70(2): 227-233.
[21]
Vande Walle J, Mauel R, Raes A, et al. ARF in children with minimal change nephrotic syndrome may be related to functional changes of the glomerular basal membrane [J]. Am J Kidney Dis, 2004, 43(3): 399-404.
[22]
LIU BC, TANG TT, LV LL, et al. Renal tubule injury: a driving force toward chronic kidney disease[J]. Kidney Int, 2018, 93(3): 568-579.
[1] 张婧琦, 江洋, 孙佳璐, 唐兴喆, 赵宇飞, 崔颖, 李信响, 戴景月, 傅琳, 彭新桂. 基于肾周CT特征结合血清肌酐水平探讨脓毒症伴急性肾损伤的早期识别[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 285-292.
[2] 樊恒, 孙敏, 朱建华. 红景天苷通过抑制PI3K/AKT/mTOR信号通路对大鼠脓毒症急性肾损伤的保护作用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 188-195.
[3] 张锦丽, 席毛毛, 褚志刚, 栾夏刚, 陈诺, 王德运, 谢卫国. 大面积烧伤患者发生早期急性肾损伤的危险因素分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 282-287.
[4] 国家人体捐献器官获取质量控制中心, 中国医院协会器官获取与分配工作委员会, 中国医师协会器官移植医师分会移植质控专业委员会. 成人脑死亡潜在器官捐献者的护理专家共识[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 193-203.
[5] 彭瑞, 杨瑞文, 魏澹宁, 夏永良. 琥珀酸受体1加重肾脏缺血再灌注损伤的作用研究[J/OL]. 中华移植杂志(电子版), 2024, 18(03): 159-164.
[6] 徐杨荣, 杨毅, 王凤飞, 潘姣. 腹腔镜增强视野完全腹膜外疝修补术和腹腔镜腹膜内补片修补术在腹壁疝修补中的安全性及临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 296-301.
[7] 吴洁柔, 王琴, 张静, 周耿标, 赖芳, 韩云. 体质量指数、血清白蛋白联合mNUTRIC评分对重症肺炎预后的意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 392-396.
[8] 杜霞, 马梦青, 曹长春. 造影剂诱导的急性肾损伤的发病机制及干预靶点研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 279-282.
[9] 郭俊楠, 林惠, 任艺林, 乔晞. 氨基酸代谢异常在急性肾损伤向慢性肾脏病转变中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 283-287.
[10] 赵静, 张嘉欣, 高言, 谢席胜. 微小病变肾病的发病机制及治疗研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 207-212.
[11] 袁楠, 黄梦杰, 白云凤, 李晓帆, 罗从娟, 陈健文. 急性肾损伤-慢性肾脏病转化小鼠模型制备的教学要点及学习效果分析[J/OL]. 中华肾病研究电子杂志, 2024, 13(04): 226-230.
[12] 林玲, 李京儒, 沈瑞华, 林惠, 乔晞. 基于生物信息学分析小鼠急性肾损伤和急性肺损伤的枢纽基因[J/OL]. 中华肾病研究电子杂志, 2024, 13(03): 134-144.
[13] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[14] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文
0
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 0


摘要
44
最新录用 在线预览 正式出版
0 0 44
  来源 本网站 其他网站
  次数 21 24
  比例 47% 53%

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号