干燥综合征合并肾脏损害患者远期预后及影响因素分析

摘要

目的 探讨干燥综合征合并肾脏损害(renal involvement in Sj(o)gren syndrome,RISS)患者的远期预后及影响因素分析.方法 回顾性研究2005年1月至2010年1月内蒙古医科大学附属医院肾内科收治的104例RISS患者,所有患者均接受免疫抑制剂治疗,以血肌酐水平是否倍增评价患者的远期预后,分为预后良好组与预后不良组,并分析相关影响因素.结果 随访2～10年期间104例RISS患者中有19例患者血肌酐水平倍增,即预后不良发生率为18.27％.单因素分析显示,性别、血肌酐、球蛋白、尿蛋白、免疫球蛋白G及肾间质慢性化程度分级与RISS预后不良相关.多因素Logistic回归分析显示,球蛋白、尿蛋白、免疫球蛋白G是远期不良预后的独立危险因素.Pearson相关性分析显示,球蛋白、免疫球蛋白G、尿蛋白与患者血肌酐水平呈显著正相关.ROC曲线显示:尿蛋白曲线下面积为0.825、最佳阈值为0.66 g/24h时,其预测RISS预后不良的敏感度为0.826,特异度为0.764;球蛋白曲线下面积为0.845、最佳阈值为54.36 g/24h时,敏感度为0.816,特异度为0.762;IgG曲线下面积为0.812、最佳阈值为34.72 g/L时,敏感度为0.806,特异度为0.752.结论 球蛋白、尿蛋白及免疫球蛋白G与RISS不良预后密切相关,且球蛋白、尿蛋白、免疫球蛋白G对RISS预后具有较好的预测价值.%Objective To analyze the long-term prognosis and influencing factors of renal involvement in Sj(o)gren syndrome (RISS).Methods A total of 104 patients with RISS in Department of Nephrology in our hospital from January 2005 to January 2010 were selected as the research objects,and all wer given immunosuppressive agents.To assess whether doubled blood creatinine as standard can accurately evaluate the long-term prognosis of the patients,good prognosis group and poor prognosis group were set up,and the influencing factors were analyzed.Results During the follow-up period of 2-10 years,the incidence of poor prognosis was 18.27％.Univariate analysis showed that the poor prognosis of RISS was associated with female,serum creatinine,globulin,albumin,serum IgG,chronic renal tubulointerstitial lesions.Multiple Logistic regression revealed that globulin,albumin and serum IgG were the independent risk factors for poor prognosis of RISS.Pearson correlation analysis indicated that globulin,albumin and serum IgG levels were positively correlated with serum creatinine level (P＜0.05).ROC curve analysis demonstrated that the optimal cutoff of globulin to predict renal damage was 0.66 g/24h (AUC =0.825,sensitivity 0.826,specificity 0.764),that of albumin was 54.36 g/24h (AUC =0.845,sensitivity 0.816,specificity 0.762),and that of IgG was 34.72 g/L (AUC=0.812,sensitivity 0.806,specificity 0.752).Conclusions The globulin,albumin and serum IgG are positively correlated with the incidence of poor prognosis,suggesting that globulin,albumin and serum IgG are of early assessment value for poor prognosis in RISS.