专尿预测IgA脏病发作中的事件
Anne-Laure Faucon1,2, Sigrid Lundberg3,4,5, Stefania Lando1,6
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
概括
患有免疫球蛋白A脏病 (IgAN) 和低级蛋白尿 (0.3-1.0 g/g) 的患者面临严重的病进展风险. 减少尿中的白蛋白与肌素比率 (uACR) 改善了脏结果,无论最初的水平如何.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
- 内部医学 内部医学
背景情况:
- 免疫球蛋白A脏病 (IgAN) 是慢性脏病 (CKD) 的主要原因之一.
- 由于进展风险高,KDIGO指南针对Igan患者的蛋白尿 <1g/天.
- 低级蛋白尿症IGAN患者的长期结局尚未研究.
研究的目的:
- 为了研究长期Igan患者的结局,Igan患者具有不同水平的蛋白尿.
- 评估尿白蛋白与肌素比率 (uACR) 类别与重大脏不良事件 (MAKE) 之间的关联.
- 评估uACR变化对脏事件风险的影响.
主要方法:
- 来自瑞典脏注册局的1269名活检证明的Igan患者的分析.
- 对uACR的分类为<0.3,0.3-0.5,0.5-1.0,1.0-1.5,1.5-2.0和≥2.0g/g. 这两种类型.
- 评估MAKE (脏替代疗法或>30%的eGFR下降) 和uACR变化在一年内.
主要成果:
- 较高的uACR类别 (≥0.3g/g) 与MAKE,替代疗法和eGFR下降的风险增加有显著关联.
- 与uACR<0.3g/g相比,MAKE的调整危险比率在较高的uACR类别中从1.56到4.53不等.
- 一年内uACR下降2倍与降低事件风险相关 (HR 0.47-0.49),而增加2倍则增加了风险 (HR 1.18-2.56).
结论:
- 与目前的低风险看法相反,Igan患者的uACR在0.3至1.0g/g之间面临严重的脏不良结果风险.
- 降低uACR与改善脏结局有关,无论最初的uACR水平如何.
- 这项研究强调了监测和管理Igan患者蛋白尿的重要性,即使那些最初水平较低的患者也是如此.
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