关键词: 肾炎, 紫癜性肾炎, 贫血, 疾病特征, 预后, 影响因素分析

Abstract: Background　Henoch-Schonlein purpura nephritis（HSPN） is a major cause of chronic kidney disease. Anemia is a common presentation of HSPN，which seriously affects the life quality. Objective　To analyze the association of anemia with clinicopathological characteristics and prognosis in HSPN patients. Methods　Participants were 195 HSPN patients with and without anemia recruited from the First Affiliated Hospital of Zhengzhou University from December 2014 to July 2019. Clinical data〔including age，gender，baseline extrarenal manifestations（joints/ abdomen），hypertension，white blood cell count，hemoglobin，serum calcium，serum phosphorus，blood urea nitrogen，serum creatinine，serum uric acid，serum total protein，serum albumin，cholesterol，triglyceride，high-density lipoprotein，low-density lipoprotein，estimated glomerular filtration rate （eGFR），24-hour urine protein，urinary RBC count〕 and pathological data（including IgG deposition，IgM deposition，IgA deposition，C3 deposition，renal interstitial fibrosis，renal interstitial inflammation，renal tubule atrophy，arteriolar disease，prevalence of crescent formation，glomerulosclerosis rate，pathological grade） were collected. All of them were followed up as of December 2019. Composite adverse outcomes were also collected. Kaplan-Meier curve was plotted to estimate the renal survival. Log-rank test was used to compare the survival of patients with and without anemia. Multivariate Cox regression analysis was adopted to explore the influence factors for prognosis. Results　Patients with anemia（n=63） had older mean age，higher rate of having extrarenal manifestations at admission，and higher mean levels of blood urea nitrogen，24-hour urine protein，and urinary RBC count than those without（n=132）（P<0.05）. Moreover，patients with anemia demonstrated lower mean levels of hemoglobin，serum calcium，total protein，albumin，high-density lipoprotein，and eGFR（P<0.05）. Furthermore，greater severity of arteriolar disease and higher prevalence of crescent formation were found in those with anemia（P<0.05）. Multivariate Cox regression analysis suggested that older age，24-hour urine protein and glomerulosclerosis were associated with increased risks of poor prognosis of HSPN（P<0.05）. Survival analysis showed that patients with anemia had lower cumulative renal survival rate than those without （χ2=4.675，P=0.031） . Conclusion　HSPN patients with anemia presented more serious clinicopathological features，and a lower renal cumulative survival rate. Older age，24-hour urine protein and glomerulosclerosis may be influence factors for composite adverse outcomes.

Key words: Nephritis, Henoch-schonlein purpura nephritis, Anemia, Disease attributes, Prognosis, Root cause analysis