大量蛋白尿作为血栓性微血管病的恶性高血压患者肾脏预后的预测指标：一项前瞻性队列研究
Significant proteinuria as a predictor of renal prognosis in malignant hypertension patients with thrombotic microangiopathy: a prospective cohort study.
作者信息
Shi Wanxin, Lian Xingji, Li Wenchuan, Lian Rong, Yu Shengyou, Dai Zefang, Zhong Zhong, Wang Yiqin, Chen Wei, Li Jianbo, He Feng
机构信息
Department of Nephrology, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China.
Department of Geriatrics, Guangzhou First People's Hospital, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, China.
出版信息
BMC Nephrol. 2025 Sep 2;26(1):513. doi: 10.1186/s12882-025-04407-6.
BACKGROUND
Malignant hypertension (mHTN) is the most severe form of hypertension. Thrombotic microangiopathy (TMA) serves as both a complication of mHTN and a contributor to its progression by exacerbating renal damage. Proteinuria is a common manifestation of mHTN. However, the impact of proteinuria on renal prognosis in mHTN patients with TMA is unclear.
METHODS
This observational cohort study included 276 mHTN-associated TMA patients based on renal biopsy from 2008 to 2023. Demographic characteristics, laboratory results, and histopathological findings were recorded and compared between the mild (< 1 g / 24 h) and significant (≥ 1 g / 24 h) proteinuria groups. Propensity score matching (PSM) was used to adjust for baseline differences. Cox regression model was employed to evaluate risk factors associated with renal prognosis.
RESULTS
Among the 276 patients included in the study, 185 (67.0%) had significant proteinuria, while 91 (33.0%) had mild proteinuria at baseline. After PSM, 83 pairs of patients with mHTN-associated TMA were matched. Patients with significant proteinuria exhibited lower serum albumin, and higher ratio of global sclerosis compared to patients with mild proteinuria. Moreover, mHTN-associated TMA with significant proteinuria was independently associated with receiving renal replacement therapy (RRT) (adjusted hazard ratio (aHR), 1.30; 95% confidence interval (CI), 1.16-1.46; P < 0.001) compared with mild proteinuria. This association remained significant after PSM (aHR, 1.29; 95% CI, 1.13-1.47; P < 0.001). Furthermore, mHTN-associated TMA patients with significant proteinuria had a lower incidence of renal function recovery with a reduction in creatinine levels than in patients with mild proteinuria in the absence of intensive blood pressure control.
CONCLUSION
In mHTN-associated TMA patients, the presence of significant proteinuria serves as a strong predictor of poor renal outcome.
CLINICAL TRIAL NUMBER
Not applicable.
背景
恶性高血压（mHTN）是高血压最严重的形式。血栓性微血管病（TMA）既是mHTN的一种并发症，又通过加剧肾损伤促进其进展。蛋白尿是mHTN的常见表现。然而，蛋白尿对合并TMA的mHTN患者肾脏预后的影响尚不清楚。
方法
这项观察性队列研究纳入了2008年至2023年基于肾活检的276例mHTN相关TMA患者。记录并比较轻度（<1 g/24小时）和重度（≥1 g/24小时）蛋白尿组的人口统计学特征、实验室检查结果和组织病理学发现。采用倾向评分匹配（PSM）来调整基线差异。采用Cox回归模型评估与肾脏预后相关的危险因素。
结果
在纳入研究的276例患者中，185例（67.0%）基线时有重度蛋白尿，而91例（33.0%）有轻度蛋白尿。PSM后，匹配了83对mHTN相关TMA患者。与轻度蛋白尿患者相比，重度蛋白尿患者血清白蛋白水平较低，肾小球硬化比例较高。此外，与轻度蛋白尿相比，重度蛋白尿的mHTN相关TMA独立与接受肾脏替代治疗（RRT）相关（调整后风险比（aHR），1.30；95%置信区间（CI），1.16 - 1.46；P < 0.001）。PSM后这种关联仍然显著（aHR，1.29；95% CI，1.13 - 1.47；P < 0.001）。此外，在没有强化血压控制的情况下，重度蛋白尿的mHTN相关TMA患者肾功能恢复且肌酐水平降低的发生率低于轻度蛋白尿患者。
结论
在mHTN相关TMA患者中，重度蛋白尿的存在是肾脏预后不良的有力预测指标。
临床试验编号
不适用。
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