IgA肾病患者肾内小动脉病变的临床及病理意义  

Clinical and pathological significance of intrarenal arteriolar lesions in the patients with IgA nephropathy with or without hypertension

作　　者：陈天怡[1] 谌贻璞[1] 董鸿瑞[1] 王国勤[1] 程虹[1] 

机构地区：[1]首都医科大学附属北京安贞医院肾内科,北京100029

出　　处：《中国实用内科杂志》2014年第4期391-394,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的建立IgA肾病小动脉病变评估标准；了解伴或不伴高血压的IgA肾病患者肾内小动脉病变状态及其意义。方法纳入首都医科大学附属北京安贞医院肾内科2010年3月至2013年10月确诊为IgA肾病的患者305例，用计算机图像分析软件测量肾内小动脉内、外直径，评估管壁增厚程度，分析它们与临床及病理表现的联系。结果小动脉病变评估标准：肾内小动脉内外径比〉0．48正常，0．45～O．48轻度增厚，〈0．45重度增厚。IgA肾病患者管壁增厚组的收缩压、舒张压、血肌酐（sCr）及缺血硬化肾小球（IGS）百分比较正常组均显著升高（P〈0．05），尿渗透压（UOP）显著降低（P〈0．05）。在血压正常的IgA肾病患者中，管壁增厚组的sCr及IGS百分比较正常组均显著升高（P〈0．05），UOP均降低，但仅重度组差异有统计学意义（P〈0．05）。结论正常及高血压的IgA肾病患者均常出现肾内小动脉病变，管壁增厚，其常合并较重的肾小球及肾小管功能损伤。Objective To develop quantitative criteria for evaluating intrarenal arteriolar lesions, and to know the extent and affect of such arteriolar lesions in the patients with IgA nephropathy with or without hypertension. Methods 305 hospital- ized patients with IgA nephropathy were reviewed. The luminal diameters and outer diameters of arteriolar cross sections on kidney tissue were measured by computer image analysis software. Arteriolar wall thicknesses were assessed and the relation- ship between them and clinical and pathological manifestations was analyzed. Results The criteria of arteriolar lesions were defined as follows ： the ratio of luminal diameter to outer diameter 〉 0. 48 was normal; 0. 45 - 0. 48 mild wall thickness ; 〈 0.45 severe wall thickness. Among the total patients with IgA nephropathy, the cases of intrarenal arteriolar lesions had sig- nificantly higher systolic blood pressure, diastolic blood pressure, serum creatinine level, proportion of ischemic glomerulosclerosis and lower urine osmotic pressure compared with normal cases （ P 〈 0. 05 ）. Among the patients with IgA nephropathy and normal blood pressure, the cases of intrarenal arteriolar lesions had significantly higher serum creatinine level and proportion of ischemic glomerulosclerosis compared with normal cases （ P 〈 0. 05 ）. The significantly lower urine osmotic pressure only appeared in the cases of severe arteriolar lesions （ P 〈 0.05 ）. Conclusion Intrarenal arteriolar lesions with wall thickness often occur in IgA nephropathy with or without hypertension, and the arteriolar lesions are frequently associated with more severe glomerular and tubular dysfunction.

关 键 词：IGA肾病 肾内小动脉病变 高血压 肾功能损害 计算机图像分析 

分 类 号：R692[医药卫生—泌尿科学]