微小病变样IgA肾病的临床病理特征及激素疗效分析  

Clinicopathological features and the response to prednisone therapy of IgA nephropahty with minimal change lesion

作　　者：张希燃[1] 王庆文[2] 陈惠萍[2] 刘志红[2] 

机构地区：[1]南京大学医学院临床学院硕士研究生 [2]南京军区南京总医院全军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2011年第2期109-113,135,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:了解微小病变样IgA肾病(IgA nephropathy,IgAN)的临床病理特征及激素疗效。方法:回顾性分析61例微小病变样IgAN患者[男性46例,女性15例,平均年龄(23.92±8.65)岁]的临床和病理特征及激素诱导治疗疗效。结果:61例患者均以水肿为首发症状,其中15例(24.6%)有明确感染诱因。临床表现主要为肾病综合征,14例(23.0%)伴急性肾损伤,5例(8.2%)伴高血压,14例(23.0%)伴镜下血尿。尿N-乙酰-β-D-葡萄糖苷酶(NAG酶)(78.7%)、尿视黄醇结合蛋白(RBP)升高(75.4%)较多见。肾小球病理表现轻微,肾小管、间质急性损伤突出,比例分别为80.3%、65.6%,其中小管中～重度损伤占14.7%。足量激素诱导治疗有效率为91.8%,平均随访(46.00±13.93)月(24～70月),复发率为76.8%。与激素治疗有效患者相比,无效患者血尿发生率高且较严重(P<0.01),血浆白蛋白相对较高(P<0.05),肾小管萎缩、间质纤维化、小动脉透明变性多见(P<0.01)。随访结束时,59例(96.7%)肾功能正常。结论:微小病变样IgAN临床及病理特征均类似微小病变,激素治疗缓解率高、总体预后好。Objective： To investigate the clinicopathological features and prednisone therapeutic effect of IgA nephropathy with minimal change lesion. Methodology：Sixty one patients [ 46 male and 15 female with average age of （23.9 ± 8. 65 ） years old ] , who were biopsy-based IgA nephropathy with the minimal change lesion, were enrolled in this retrospective study. Their clinical manifestations, pathological features and prednisone therapeutic effect were analyzed. Results：Nephrotic syndrome was the primary clinical manifestation. All patients presented severe proteinuria and edema, 15 cases（24. 6% ）had infections as a motivation, i4 cases （23.0%）showed AKI, 14 cases （23.0%）had microhematuria and 5 cases（ 8.2% ）presented with hypertention. The increasing levels of urine n-acetyglucosaminidase （NAG）（ 78. 7% ） and urine retinol binding protein （RBP）（ 75.4% ）were seen in a majority. The histological examinations showed that the glomerular lesion was minimal. The renal tubules and interstitial tissues obviously got acute injury with a proportion of 80. 3% and 65.6% respectively. During the follow-up of （46. 00 ± 13.93 ） months（24 - 70 months） , the effective and relapse rate of prednisone therapy were 91.8% and 76. 8%. Compared to responders, the nonresponders got a higher incidence and severity of hematuria（ P 〈 0.01 ） and the hypoproteinemia was not as obvious as the former（ P 〈 0. 05 ）. Besides ,tubular atrophy, interstitial fibrosis and hyaline degenetantion of arteriole appeared more often in nonresponders （ P 〈 0. 01 ）. Till the last follow-up, 59 cases （96. 7% ） still had nomal renal funtion. Conclusion： IgA nephropathy with minimal change like lesion were similar with minimal change desease both in clinical menifestation and pathological feature. Most cases got remission with prednisone therapy,and they usually showed good prognosis.

关 键 词：IGA肾病 微小病变样变 临床病理特征 激素疗效 

分 类 号：R692[医药卫生—泌尿科学]