IgA肾病呈单纯血尿和(或)轻度蛋白尿临床病理分析  

A retrospective analysis of clinical and pathological characteristics of IgA nephropathy with hematuria and /or minimal proteinuria

作　　者：吕继成[1] 张宏[1] 刘刚[1] 江建青[1] 王海燕[1] 

机构地区：[1]北京大学第一医院肾内科北京大学肾脏病研究所,100034

出　　处：《中华肾脏病杂志》2004年第6期418-420,共3页Chinese Journal of Nephrology

基　　金：首都医学发展科研基金(ZD199910)北京大学人类功能基因与疾病基因研究学科群课题

摘　　要：目的 探讨单纯血尿和／或轻度蛋白尿IgA肾病患者病理特点及临床病理相关性,并进行危险因素分析。方法 选取肾脏疾病数据库1988-2001年我科收住的248例临床表现为单纯血尿和／或伴有轻度蛋白尿(尿蛋白定量≤1.0 g／d)的IgA肾病患者,血压、肾功能均正常,采用单盲法进行临床和病理分级(Haas分级),多因素回归分析法进行病理损伤的危险因素评估。结果(1)临床特点:49％(121例)患者同时存在血尿和蛋白尿,47％(117例)为单纯血尿,4％(10例)为单纯蛋白尿;(2)病理特点:35.5％(88例)病理损伤偏重,Haas分级Ⅱ-Ⅳ级。蛋白尿是病理损伤偏重(HaasⅡ级以上)的独立危险因素(OR=3.46,95％CI:1.54-7.79,P=0.002)。随着蛋白尿程度的增加,其病理损伤偏重的危险性亦明显增加。结论 相当一部分临床表现轻微的IgA肾病患者病理偏重,蛋白尿是危险因子,即使轻度蛋白尿亦和病理损伤明显相关。对于怀疑IgA肾病患者,尽管只有少量蛋白尿亦应进行肾活检,有助于发现病理损伤偏重的患者。Objective To study the pathological features of IgA nephropathy with hematuria and/ or mild proteinuria and the risk factors associated with the renal lesions. Methods Two hundred and forty-eight biopsy proved IgA nephropathy patients were collected from Chinese Renal Disease Database (http: //www. renal-online, org), who presented with isolated hematuria and/or mild proteinuria (1. 0 g/d or less) . The activity and severity of renal pathological lesions were graded single-blindedly according to Haas M. classification. The relationship between renal lesions and clinical factors was studied, and the predicted factors were analyzed using step-wise multiple variance regression analysis. Results All patients were normotensive and had normal renal function. (1) Among these patients 49% (121 cases) presented with both hematuria and proteinuria, 47% (117 cases) with isolated hematuria, and another 4% (10 cases) with pure proteinuria. (2) As for renal pathological changes, 35. 5% (88 cases)were unexpectedly Grade Ⅱ to Ⅳ (Haas M. classification), including one focal necrotic IgA nephropathy. 39% (97 cases) had 1.8% to 38. 2% global glomerulosclerosis, and 25% (61 cases) with focal interstitial fibrosis. (3)Proteinuria at the time of renal biopsy (odds ratio [OR] =3.46, 95% confidence interval [CI] 1. 54 to 7. 79, P = 0. 002) was an independent predictor of the severity of renal pathologic lesion ( Haas Ⅱ or more). Conclusion Early stage IgAN patients with mild proteinuria should receiv renal biopsy properly. Mild proteinuria may predispose offspring to severe renal pathological lesion (Haas Grade Ⅱ or more)which may lead to a severe renal dysfunction.

关 键 词：蛋白尿 IGA肾病 血尿 患者 轻度 病理损伤 临床病理分析 结论 单盲法 目的 

分 类 号：R692.3[医药卫生—泌尿科学]