肾病综合征表现的IgA肾病临床病理特点及危险因素  

Risk factors,Clinical and Pathological Analysis of IgA Nephropathy Presenting with Nephrotic Syndrome

作　　者：列才华[1] 梁兰青[1] 冯维[1] 阿孜古丽[1] 黄海[1] 王建平[1] 王小丽[1] 倪雪芳[1] 

机构地区：[1]兰州军区乌鲁木齐总医院肾内科,新疆乌鲁木齐830000

出　　处：《新疆医学》2011年第2期3-6,共4页Xinjiang Medical Journal

摘　　要：目的:探讨肾病综合征表现的IgA肾病患者临床病理特点及其危险因素。方法:选择我科1993年6月～2008年12月经肾活检确诊IgA肾病并表现为肾病综合征的患者48例,分析其临床病理特点,按治疗是否完全缓解分为完全缓解组(A组,n=13)、不完全缓解组(B组,n=35),比较两组临床、实验室指标及病理指标,分析影响肾病综合征表现的IgA肾病患者肾脏损害的危险因素。结果:IgA肾病肾病综合征患者合并高血压占56.3%,合并慢性肾功能不全占20.8%;肾活检病理Lee分级Ⅰ级4例(8.3%),Ⅱ级9例(18.8%),Ⅲ级6(12.5%),Ⅳ级19例(39.6%)、Ⅴ级10例(20.8%)。B组较A组平均动脉压、血肌酐水平高,镜下大量尿红细胞发生率高(P<0.01);而24h尿蛋白定量、血红蛋白低于A组(P<0.05);病理参数分析示B组肾脏病理损害积分显著高于A组(P<0.05),系膜区IgA+IgG+IgM沉积显著高于A组(P<0.001)。结论:IgA肾病肾病综合征患者临床、病理表现存在差异,高血压、贫血、血肌酐高、镜下大量尿红细胞是其预后不良的临床危险因素,预后差者肾脏病理损害重、免疫复合物沉积以系膜区IgA+IgG+IgM沉积多见。Objective To study the clinical and pathological characteristics of IgA nephropathy patients with nephrotic syndrome and the relative risk factors.Methods Between June 1993 to 48 patients with nephrotic syndrome were collected from our department the inpatients who were diagnosised as IgA nephropathy by renal biopsy.The clinical and pathological features of patients were analyzed.And then all patients were divided into two groups,according to the clinical remission of treatment（group A,complete clinical remission group,n = 13;Group B,partial remission group,n = 35 ）,clinical index of the two groups were compared, as well as the relationship between renal pathologic lesions and clinical factors were studied,and the predicted factors were analyzed,too.Results Among these patients,56.3%accompanied by hypertension, 20.8%with chronic renal failure.As for renal pathological changes,4 cases（13.6%） were GradeⅠ（Lee SM.classification）,9 cases（18.8%） were GradeⅡ,6 cases（12.5%） were GradeⅢ,19（39.6%）,10 （20.8%） were GradeⅣandⅤ,respectively.The partial remission group has more higher level of mean arterial pressure,serum creatinine,and incidence of mass hematuria than those of complete remission group. while,the excretion of urinary protein per day,level of hemoglobin were lower than those of group A.Scores of pathological lesion increased significantly in group B（P0.05 ）.It showed that the proportion of type IgA ＋ IgG ＋ IgM immunopathologically of Group B is significantly higher than that of Group A（P0.001）. Conclusion IgA nephropaty patients presenting with nephrotic syndrome have different clinical manifestations and pathologic lesions,Patients accompanied by hypertension,anemia,high serum creatine and mass hematuria, were the clinical risk factors for poor prognosis.The more poor of prognosis the more severity of renal lesions .with decreased hemoglobin have more severity renal lesions and immunopathological type of IgA ＋ IgG ＋ IgM is very common.

关 键 词：IGA肾病 肾病综合征 临床 病理 

分 类 号：R586[医药卫生—内分泌]