Objective: To identify the risk factors of poor outcome in patients with IgA nephropathy by retrospective cohort study.Methods: We enrolled 622 patients who were diagnosed as IgA nephropathy by renal biopsies and followed up regularly.All baseline clinical data were recorded and regular follow-up was performed.The survival rate was calculated by Kaplan-Meier method and risk factors were evaluated by univariate and multivariate COX proportional-hazards regression.Results: The 1-, 3-and 5-year cumulative renal survival rate was 99.6%, 98.4% and 91.9% respectively.Multivariate COX analysis showed that CKD stages (HR: 4.79, 95% CI: 1.25-18.36, P=0.022), 24h protein excretion (HR: 5.08, 95% CI: 1.04-24.83, P=0.045) and serum C3 (HR: 0.01, 95% CI: 0.010.59, P=0.016) were significantly independent risk factors.Conclusion: 8.1% patients of IgA nephropathy have 50% decrease in eGFR or progress to end stage renal disease within 5 years.Three clinical features-impaired renal function, higher proteinuria and lower serum C3-are independent predictors of poor outcome in patients with IgA nephropathy.%目的:探讨影响IgA肾病患者预后的危险因素.方法:选取诊断为IgA肾病患者622例的基本资料,肾脏终点为患者肾小球过率(eGFR)下降50%或发生终末期肾病(ESRD).采用Kaplan-Meier方法计算生存率,使用单因素及多因素COX回归分析影响IgA肾病患者预后的危险因素.结果:全部患者1年、3年、5年肾脏生存率分别为99.6%,98.4%,91.9%.多因素COX回归分析结果显示患者肾活检时慢性肾脏病(CKD)分期(HR:4.79,95%CI:1.25~18.36,P=0.022)、24h尿蛋白定量(HR:5.08,95%CI:1.04~24.83,P=0.045)和血清补体C3(HR:0.01,95%CI:0.01~0.59,P=0.016)是IgA患者疾病进展的独立危险因素.结论:8.1%的IgA肾病患者在5年之内eGFR下降50%或进展为ESRD,肾活检时肾功能不全、高24h尿蛋白定量以及低血清补体C3是预后的独立危险因素.
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