Lu Wanjun, Gong Shuhao, Li Juan, Wang Ying
Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China.
Exp Ther Med. 2020 Apr;19(4):2615-2621. doi: 10.3892/etm.2020.8506. Epub 2020 Feb 10.
The present study analyzed the clinicopathological features and prognosis in patients with idiopathic membranous nephropathy (IMN) with hypertension. In the hypertension group, significant differences were found in the age, hypertension history, systolic blood pressure, diastolic blood pressure (DBP), mean arterial pressure, albumin, serum creatinine, low-density lipoprotein, 24 h urine protein levels, calculated estimated glomerular filtration rate (e-GFR), glomerular sclerosis, segmental sclerosis, ischemic sclerosis, interstitial fibrosis, tubular atrophy and vascular lesion compared with the non-hypertension group (P<0.05). The average follow-up time was 35.70 months (5.10-103.77 months). In total, 54 patients reported a 50% decline in e-GFR, eight patients reported progression of disease to end-stage renal disease (ESRD) and nine cases of mortality were reported. Survival analysis results suggested that patients with hypertension had a lower cumulative renal survival rate than those without hypertension (P=0.034). Multivariate Cox hazards regression analysis results suggested that DBP [hazard ratio (H), 5.160; CI, 0.865-0.989; P=0.023], age (H, 4.839; CI, 1.008-1.142; P=0.028), sex (H, 5.680; CI, 0.031-0.714; P=0.017), serum creatinine (H, 20.920; CI, 1.035-1.089; P<0.001), uric acid (H, 4.783; CI, 0.982-0.0.999; P=0.029), 24 h urine protein (H, 6.318; CI, 1.079-1.850; P=0.012), e-GFR (H, 4.008; CI, 1.001-1.062; P=0.045) and glomerular sclerosis (H, 8.722; CI, 1.860-21.559; P=0.003), segmental sclerosis (H, 7.737; CI, 7.770-13.219; P=0.005), percentage of ischemic sclerosis (H, 4.729; CI, 1.444-11.945; P=0.030), crescents (H, 5.938; CI, 0.003-0.526; P=0.015), interstitial fibrosis and tubular atrophy (H, 8.128; CI, 0.005-1.052; P=0.043), and vascular lesion (H, 4.049; CI, 1.030-9.766; P=0.044) were risk factors for the development of IMN into ESRD. The results suggested that DBP may be an independent risk factor for the development of IMN with hypertension.
本研究分析了特发性膜性肾病（IMN）合并高血压患者的临床病理特征及预后。在高血压组中，与非高血压组相比，年龄、高血压病史、收缩压、舒张压（DBP）、平均动脉压、白蛋白、血清肌酐、低密度脂蛋白、24小时尿蛋白水平、计算的估计肾小球滤过率（e-GFR）、肾小球硬化、节段性硬化、缺血性硬化、间质纤维化、肾小管萎缩及血管病变存在显著差异（P<0.05）。平均随访时间为35.70个月（5.10 - 103.77个月）。共有54例患者报告e-GFR下降50%，8例患者报告疾病进展至终末期肾病（ESRD），9例患者报告死亡。生存分析结果显示，高血压患者的累积肾脏生存率低于无高血压患者（P = 0.034）。多因素Cox风险回归分析结果表明，DBP[风险比（H），5.160；可信区间（CI），0.865 - 0.989；P = 0.023]、年龄（H，4.839；CI，1.008 - 1.142；P = 0.028）、性别（H，5.680；CI，0.031 - 0.714；P = 0.017）、血清肌酐（H，20.920；CI，1.035 - 1.089；P<0.001）、尿酸（H，4.783；CI，0.982 - 0.0.999；P = 0.029）、24小时尿蛋白（H，6.318；CI，1.079 - 1.850；P = 0.012）、e-GFR（H，4.008；CI，1.001 - 1.062；P = 0.045）以及肾小球硬化（H，8.722；CI，1.860 - 21.559；P = 0.003）、节段性硬化（H，7.737；CI，7.770 - 13.219；P = 0.005）、缺血性硬化百分比（H，4.729；CI，1.444 - 11.945；P = 0.030）、新月体（H，5.938；CI，0.003 - 0.526；P = 0.015）、间质纤维化和肾小管萎缩（H，8.128；CI，0.005 - 1.052；P = 0.043）以及血管病变（H，4.049；CI，1.030 - 9.766；P = 0.044）是IMN发展为ESRD的危险因素。结果表明，DBP可能是IMN合并高血压发展的独立危险因素。
