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題名 | Long-Term Outcome of IgA Nephropathy--Experience of a Single Center=IgA腎絲球腎炎長期追蹤結果--單一醫學中心的經驗 |
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作者 | 蘇碩凱; 文美卿; 鄭志雄; 吳明儒; 陳呈旭; 游棟閔; 莊亞雯; 黃亞婷; 徐國雄; Su, Shuo-kai; Wen, Mei-chin; Cheng, Chi-hung; Wu, Ming-ju; Chen, Cheng-hsu; Yu, Tung-min; Chuang, Ya-wen; Huang, Shih-ting; Shu, Kuo-hsiung; |
期刊 | 臺灣腎臟醫學會雜誌 |
出版日期 | 20100300 |
卷期 | 24:1 2010.03[民99.03] |
頁次 | 頁24-32 |
分類號 | 415.812 |
語文 | eng |
關鍵詞 | IgA腎病; 預後; 風險因子; IgA nephropathy; Prognosis; Risk factor; |
中文摘要 | 背景:A型免疫球蛋白腎病(IgA腎病)為世界最常見的原發性腎絲球腎炎,臺灣人罹患IaA腎病之長期追蹤結果及其預後因子,至今仍不十分清楚。方法:此為回溯性研究,從過去台中榮總25年來接受腎臟切片的資料庫中,挑出IgA腎病的病例。腎炎皆由組織學證明,以調閱病例方式進行研究。若資料不足則剔除。其中一部分的病理分級是根據Haas et al^2所提出的評量方式。結果:共436位病人被納入此研究,男:女=241:195(55.5%:44.5%),平均追蹤7.0±6.1年(中位數:5.5年)。接受腎臟切片的平均年齡是35.4±13.7年,從有症狀到接受切片的時問為1.4±2.7年(中位數:0.3年)。至最後追蹤時,256位病人(58.7%)有各種程度不一的腎功能不全。與腎功能穩定或是痊癒的病人相較,這256個病人最初的血清肌酐酸較高(3.2±3.7vs.1.3±0.7mg/dl, p<0.0001),最初尿蛋白較高(2.5±2.6vs.2.4±4.0gm/day, p<0.0001),較高比例有C型肝炎帶原(14.3%vs.4%, P<0.005)。在Hass sub-classification有較高的比例級別較高(21.8%為第五級,穩定組則僅有1.1%認第五級,p<0.0001)。結論:我們在長期追蹤IgA腎病變時發現,有相當比例的病人腎功能衰退,諸多實驗數據譬如初始腎功能,尿蛋白,以及腎臟病理嚴重程度,將可預測日後腎功能衰退情況,對這些病人有必要採進一步積極之治療,以期防止病情持續惡化。 |
英文摘要 | Background: IgA nephropathy (IgA N) is the worldwide most common primary glomerulonephritis. The long-term outcome and the prognosis factors of IgA N in Taiwanese patients have rarely been addressed. Methods: We retrospectively reviewed our kidney biopsy database of the past 25 years. Cases with biopsy-proven IgA N were identified and medical charts were reviewed. Patients with inadequate data were excluded. A proportion of cases (157 patients) have adequate biopsy tissue to give further pathological classification according to the criteria suggested by Haas et al2. The patients were divided into subgroups according to their outcome at last follow-up. The "stable" group includes patients in remission (normal renal function, no more hematuria defined as RBC < 2/HPF and proteinuria <0.2 gm/day) and patients with stable renal function without signs of progression (variation in serum creatinine level less than 10% with or without hematuria/proteinuria). The "progressive" group includes patients with deteriorating renal function (serum creatinine increased by more than 10%) and patients with end-stage renal disease (ESRD). We compare the differences in several parameters, such as initial level of creatinine, proteinuria, and pathological subclass, between the two groups. Results: A total of 436 cases (male: female =241:195, 55.5%: 44.5%) with a mean follow-up duration of 7.0 ± 6.1 years (median: 5.5 years) were enrolled fur the study. The mean age at biopsy was 35.4 ± 13.7 years, while the duration of apparent disease onset to biopsy was 1.4 ± 2.7 years (median: 0.3 years). At last follow-up, 256 cases (58.7%) had various degrees of renal function deterioration. Compared with patients in remission or with stable renal function, the progressive group had higher baseline serum creatinine (3.2 ± 3.7 vs. 1.3 ± 0.7 mg/dl, p <0.0001), higher urine protein (2.5 ± 2.6 vs. 2.4 ± 4.0 gm/day, p<0.0001), and higher incidence of hepatitis C virus infection (14.3% vs. 4%, p<0.005). The progressive groups also tended to have higher grade of Haas's subclassification (21.8% with subclass 5, compared with 1.1% in the stable group, p<0.0001). Conclusion: We conclude that a significant proportion of IgA N patients may progress to renal insufficiency in the long run. Baseline characteristics including laboratory exam at onset and pathological-finding may predict long-term outcome and are worth further investigation. |
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