Chinese Medical Sciences Journal ›› 2018, Vol. 33 ›› Issue (2): 91-99.doi: 10.24920/11809

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  1. 1 中国医学科学院 北京协和医学院,北京协和医院 肾内科,北京 100730 中国
    2 中国医学科学院 北京协和医学院,北京 100730 中国
  • 收稿日期:2017-10-20 出版日期:2018-06-30 发布日期:2018-05-07
  • 通讯作者: 李学旺

A Cohort Study of Incidences and Risk Factors for Thromboembolic Events in Patients with Idiopathic Membranous Nephropathy

Zou Peimei1,Li Hang1,Cai Jianfang1,Chen Zhenjie1,Li Chao1,Xu Ping2,Li Mingxi1,Chen Limeng1,Li Xuemei1(),Li Xuewang1,*   

  1. 1 Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;
    2 Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China;
  • Received:2017-10-20 Published:2018-06-30 Online:2018-05-07
  • Contact: Li Xuewang


目的 评估特发性膜性肾病(IMN)患者队列中动脉血栓栓塞事件(ATEs)和静脉血栓栓塞事件(VTEs)的发生率及其特点,并探索其相关危险因素。方法 回顾性研究队列共纳入766名连续中国人IMN患者,以Kaplan-Meier模型统计新发的ATEs和VTEs的累积发病率,以单因素和多因素风险回归分析其可能的危险因素。结果 在肾活检诊断为IMN后的第0.5、1、2、3、5年中,ATEs的累积发病率分别为4.3%、5.7%、6.3%、7.1%和8.0%,VTEs的累积发病率分别为5.9%、6.8%、6.9%、7.0%和7.2%。在78起ATE事件(71例)中,心血管疾病、血栓性缺血性脑卒中和外周动脉性疾病分别占比50%、45%和5%;在60起VTE事件(53例)中,深静脉血栓、肾静脉血栓和肺栓塞分别占比60%、13%和27%。ATE和VTE事件发生时,分别有42.1%和81.5%的患者处于肾病综合征(NS)状态(χ 2=18.1,P < 0.001)。ATEs与大量蛋白尿、年龄、吸烟史、高血压和既往ATE史相关,其中年龄是ATEs的独立危险因素(P=0.001),低白蛋白血症为VTEs主要独立危险因素(P=0.03)。 结论 IMN患者ATEs和VTEs发病率高,尤其在病程的前6个月内。ATEs中IS占比高。大量蛋白尿和动脉粥样硬化经典危险因素与ATEs的发生相关,低白蛋白血症为VTEs的独立预测因素。肾病综合征状态时ATEs和VTEs的发生风险增高,特别是VTEs。

关键词: 特发性膜性肾病, 血栓栓塞事件, 动脉, 静脉


Objective The aims of this study were to assess incidences and characteristics of arterial thromboembolic events (ATEs) and venous thromboembolic events (VTEs) in Chinese patients with idiopathic membranous nephropathy (IMN), and to identify the predisposing risk factors of them.Methods A total of 766 consecutive Chinese patients with IMN were enrolled in this retrospective cohort study. The cumulative incidences of newly diagnosed ATEs and VTEs were calculated using Kaplan-Meier methods. Univariable risk prediction model analysis followed by multivariable survival analysis was used to evaluate the potential risk factors of ATE and VTE.Results At 0.5, 1, 2, 3, and 5 years after biopsy diagnosis of IMN, the cumulative incidence of newly diagnosed ATEs were 4.3%, 5.7%, 6.3%, 7.1%, and 8.0%, and of newly diagnosed VTEs were 5.9%, 6.8%, 6.9%, 7.0%, and 7.2%, respectively. In 78 ATEs events (71 patients), cardiovascular diseases, thrombotic ischemic stroke (IS) and peripheral artery disease accounted for 50%, 45% and 5% respectively; in 60 VTEs events(53 patients), the deep vein thrombosis, renal vein thrombosis and pulmonary embolism accounted for 60%, 13% and 27% respectively. At the time of event, 42.1% patients with ATEs and 81.5% patients with VTEs were at nephrotic syndrome(NS) status (χ 2=18.1, P<0.001). Severe proteinuria, aging, smoking, hypertension and prior ATE history were associated with ATEs. Aging was demonstrated as the independent risk factor for ATEs (P=0.001), and hypoalbuminemia was the dominant independent risk factor for VTEs (P=0.03). Conclusions Patients with IMN have increased incidences of ATEs and VTEs, and most of events occurred within the first 6 months of the disease. IS was very common in ATEs in our cohort. Severe proteinuria and classic risk factors for atherosclerosis were associated with onset of ATEs. Hypoalbuminemia independently predicted VTEs. Risks of both ATEs and VTEs were particularly high in the status of NS, particularly VTEs.

Key words: idiopathic membranous nephropathy, thromboembolic events, arterial, venous

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