慢性梗阻性肾病患者继发终末期肾病的风险性及相关危重度研究

摘要

目的 预测慢性梗阻性肾病(CON)继发终末期肾脏病(ESRD)的风险性,并对其相关危重度进行评判.方法 连续性纳入解放军第105医院于2013年6月至2015年9月初次接诊的CON患者为研究队列,对其进行为期18个月的随访以确认预后.完善研究对象初始入院时的各项临床资料及实验室检查结果,依据随访结果,进行远期风险性预测和相关危重度评判分析.结果 本次研究最终纳入274例CON患者,最终255例患者完成随访,其中69例患者于随访期内进展至ESRD.Cox回归分析显示,CON患者不良预后的风险模型由完全性梗阻、尿肾损伤分子-1(uKIM-1)含量、尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)含量、尿N-乙酰-β-D-葡萄糖苷酶(uNAG)含量组成,均为CON患者于发病后18个月内继发ESRD的独立风险因素;uKIM-1≥137.01 pg/mL或uNGAL≥173.25 ng/mL的CON患者病情更重、进展至ESRD阶段的时间更短,其中uKIM-1的临界值指标具有更高的危重度评判效能(P<0.05).结论 完全性梗阻、uKIM-1、uNGAL、uNAG是CON患者继发不良预后的风险因素,且uKIM-1≥137.01 pg/mL为衡量CON病情危重度的临界点.%Objective To forecast the risk and severity of subsequent secondary end stage renal disease (ESRD) in patients with chronic obstructive nephropathy (CON). Methods The CON patients who firstly admitted to the 105th Hospital of Chinese PLA from June 2013 to September 2015 were selected as the research subjects, and were followed up to 18 months to confirm the prognosis. With the clinical data and laboratory results of the initial admis-sion,the long-term risk prediction and related risk assessment analysis were carried out based on the follow-up results. Results A total of 274 CON patients were eventually included, and follow-up analysis was completed in 255 patients, of which 69 patients progressed to ESRD during follow-up. Cox regression analysis showed that the risk model of ad-verse prognosis in patients with CON was composed of complete obstruction, urinary neutrophil gelatinase-associated lipo-calin (uNGAL), N-acetyl-beta-D-glucosaminidase (uNAG), and urinary kidney injury molecule-1 (uKIM-1), which were the independent risk factors for secondary ESRD in patients with CON within 18 months after onset. The CON patients with uKIM-1≥137.01 pg/mL or uNGAL≥173.25 ng/mL were more severe and the progress time to ESRD stage was shorter. The critical value of uKIM-1 had a higher risk of evaluation (P<0.05). Conclusion Complete obstruction, uKIM-1, uNGAL, uNAG were risk factors for secondary adverse outcomes in patients with CON, and uKIM-1≥137.01 pg/mL is the critical point to measure the severity of CON.