IgA肾病病理特征及危险因素分析  

Clinicopathological features and risk factors of IgA nephropathy

作　　者：王玉慧[1,2,3,4] 张德伟[1] 王沙西[1] 梅煜明[1] 郑红光[1] 陈建华[2] 

机构地区：[1]沈阳军区总医院肾脏病科,沈阳100840 [2]承德医学院附属第二医院肾内科,河北承德067000 [3]辽宁医学院 [4]沈阳军区总医院

出　　处：《中国实用内科杂志》2011年第12期948-950,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的研究IgA肾病的临床及病理变化特点。方法回顾性分析2005年3月至2009年7月在沈阳军区总院肾内科住院接受肾活检并经免疫病理检查确诊为原发性IgA肾病211例患者的临床及病理资料。结果肉眼血尿发病率38.3%,镜下血尿+蛋白尿发病率45.9%。具有明确的黏膜感染病史者占9.4%,发病前有明确诱因的患者占37.8%。镜下血尿+蛋白尿组水肿发病率11.1%,高血压发病率17.9%,肾功能损害发病率7.2%。211例IgA肾病患者病理分级以IgA肾病Ⅲ级为主,占63.1%。肾小球病理损害评分、系膜增殖程度积分、球性硬化积分、血管病变积分均以蛋白尿组最高(P<0.05),球性硬化积分、肾小管-间质积分以镜下血尿+蛋白尿组最高(P<0.05),对单纯蛋白尿组进行多因素Logistic回归分析显示,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素(OR值分别17.063,27.927)。结论镜下血尿+蛋白尿组及单纯蛋白尿组临床及病理改变较重,血清甘油三酯、高血压升高幅度是单纯蛋白尿组病情进展的危险因素。Objective To study the clinical and pathological characteristics of IgA nephropathy. Methods The clinical and pathological data of 211 patients with primary IgA nephropathy, diagnosed by the immune pathology of renal biopsy in the Department of Nephrology, General Hospital of Shenyang Military Command from May 2005 to July 2009,were retrospectively analyzed. Results Incidence of gross hematuria is 38.3%. Incidence of microscopic hematuria ＋ proteinuria is 45.9%. Cases with a clear history of mucosal infections is 9. 4%. Cases with a clear incentive before the onset is 37. 8%. Edema incidence of microscopic hematuria ＋ proteinuria is 11.1% , incidence of hypertension is 17. 9% ,of renal dysfunction is 7. 2%. Grade llI level of IgA nephropathy is given priority to 63. 1% in 211 cases. Proteinuria group was the highest in Glomerular pathological damage score, extent of integration of mesangial proliferation, global sclerosis points, vascular disease （ P 〈 0. 05 ） , hematuria ＋ proteinuria group was the highest in global sclerosis integral, tubular-mesenchymal （ P 〈 0. 05 ）. Multivariate Logistic regression analysis showed：increased rate of serum triglycerides, blood pressure are simply risk factors in progression of simple proteinuria （ OR values were 17. 063,27. 927）. Conclusion Clinical and pathological changes are severe in microscopic hematuria ＋ proteinuria and simple proteinuria groups, increased rate of serum triglycerides, blood pressure are risk factors in proteinuria progression.

关 键 词：IGA肾病 病理 危险因素 

分 类 号：R692.31[医药卫生—泌尿科学]