Zou Pei-Mei, Li Hang, Cai Jian-Fang, Chen Zhen-Jie, Li Chao, Xu Ping, Li Ming-Xi, Chen Li-Meng, Li Xue-Mei, Li Xue-Wang
Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2018 Jun 30;33(2):91-99. doi: 10.24920/11809.
Objective The aims of this study were to assess incidences and characteristics of arterial thromboembolic events (ATEs) and venous thromboembolic events (VTEs) in Chinese patients with idiopathic membranous nephropathy (IMN), and to identify the predisposing risk factors of them.Methods A total of 766 consecutive Chinese patients with IMN were enrolled in this retrospective cohort study. The cumulative incidences of newly diagnosed ATEs and VTEs were calculated using Kaplan-Meier methods. Univariable risk prediction model analysis followed by multivariable survival analysis was used to evaluate the potential risk factors of ATE and VTE.Results At 0.5, 1, 2, 3, and 5 years after biopsy diagnosis of IMN, the cumulative incidence of newly diagnosed ATEs were 4.3%, 5.7%, 6.3%, 7.1%, and 8.0%, and of newly diagnosed VTEs were 5.9%, 6.8%, 6.9%, 7.0%, and 7.2%, respectively. In 78 ATEs events (71 patients), cardiovascular diseases, thrombotic ischemic stroke (IS) and peripheral artery disease accounted for 50%, 45% and 5% respectively; in 60 VTEs events(53 patients), the deep vein thrombosis, renal vein thrombosis and pulmonary embolism accounted for 60%, 13% and 27% respectively. At the time of event, 42.1% patients with ATEs and 81.5% patients with VTEs were at nephrotic syndrome(NS) status (χ =18.1, P<0.001). Severe proteinuria, aging, smoking, hypertension and prior ATE history were associated with ATEs. Aging was demonstrated as the independent risk factor for ATEs (P=0.001), and hypoalbuminemia was the dominant independent risk factor for VTEs (P=0.03). Conclusions Patients with IMN have increased incidences of ATEs and VTEs, and most of events occurred within the first 6 months of the disease. IS was very common in ATEs in our cohort. Severe proteinuria and classic risk factors for atherosclerosis were associated with onset of ATEs. Hypoalbuminemia independently predicted VTEs. Risks of both ATEs and VTEs were particularly high in the status of NS, particularly VTEs.
目的 本研究旨在评估中国特发性膜性肾病（IMN）患者动脉血栓栓塞事件（ATEs）和静脉血栓栓塞事件（VTEs）的发生率及特征，并确定其易感危险因素。方法 本回顾性队列研究共纳入766例连续的中国IMN患者。采用Kaplan-Meier法计算新诊断ATEs和VTEs的累积发生率。采用单变量风险预测模型分析，随后进行多变量生存分析，以评估ATE和VTE的潜在危险因素。结果 在IMN活检诊断后的0.5、1、2、3和5年，新诊断ATEs的累积发生率分别为4.3%、5.7%、6.3%、7.1%和8.0%，新诊断VTEs的累积发生率分别为5.9%、6.8%、6.9%、7.0%和7.2%。在78例ATEs事件（71例患者）中，心血管疾病、血栓性缺血性卒中（IS）和外周动脉疾病分别占50%、45%和5%；在60例VTEs事件（53例患者）中，深静脉血栓形成、肾静脉血栓形成和肺栓塞分别占60%、13%和27%。在事件发生时，42.1%的ATEs患者和81.5%的VTEs患者处于肾病综合征（NS）状态（χ=18.1，P<0.001）。严重蛋白尿、年龄、吸烟、高血压和既往ATE病史与ATEs相关。年龄被证明是ATEs的独立危险因素（P=0.001），低白蛋白血症是VTEs的主要独立危险因素（P=0.03）。结论 IMN患者ATEs和VTEs的发生率增加，且大多数事件发生在疾病的前6个月内。在我们的队列中，IS在ATEs中非常常见。严重蛋白尿和动脉粥样硬化的经典危险因素与ATEs的发生相关。低白蛋白血症独立预测VTEs。NS状态下ATEs和VTEs的风险都特别高，尤其是VTEs。
