IgA肾病尿沉渣谱与肾脏病理改变的相关关系  

Association of urinary sediments with renal pathological patterns in IgA nephropathy

作　　者：李惊子[1] 王素霞[2] 秦小琪[3] 许远[1] 曹慧霞[4] 王亚芳[1] 鄂洁[1] 郑欣[1] 

机构地区：[1]北京大学第一医院肾内科北京大学肾脏疾病研究所卫生部肾脏疾病重点实验室慢性肾脏病防治教育部重点实验室,100034 [2]北京大学第一医院电镜室超微病理中心 [3]北京大学第一医院医学统计室 [4]河南省人民医院肾内科

出　　处：《中华肾脏病杂志》2015年第2期91-96,共6页Chinese Journal of Nephrology

摘　　要：目的探讨IgA肾病患者尿沉渣谱与肾脏病理损伤类型的相关性。方法病例来自北京大学第一医院肾内科住院的IgA肾病患者516例，采集患者肾活检日晨尿标本516份。相位差显微镜下检查尿沉渣谱改变。按照尿沉渣谱分为3型：血尿型（变形红细胞）；活动型（变形红细胞伴红细胞管型和／或偶见有核细胞管型）；进展型（多细胞、多管型，尤其蜡样管型）。肾活检组织行光镜、免疫荧光和电镜检查，确定病理改变和损伤类型。对。肾活检Et晨血尿阳性患者行尿沉渣谱与病理改变类型的相关性分析。结果（1）病理改变类型以局灶增生型最多见（75．2％）；其次为系膜增生型（7．0％）；增生硬化型（6．8％）；毛细血管内增生型（2．9％）及新月体型（2．3％）。（2）肉眼血尿检出率15．7％，肾活检日镜下血尿检出率74．8％，以单纯蛋白尿表现者6％。（3）386例患者尿沉渣谱与肾脏病理改变类型的相关性分析结果显示：血尿型占54％，主要见于无明显活动病变的局灶增生性IgA肾病或伴肾小球硬化和缺血性肾损伤，以及增生硬化性IgA。肾病和中晚期新月体病例，符合率为79．4％。活动型占35％，主要见于肾小球或肾小管间质有活动性病变者。进展型占11％，主要见于新月体性和毛细血管内增生性IgA肾病，或伴急性小管问质肾病患者。IgA肾病患者的肾脏病理有活动性病变的尿沉渣谱以活动和进展型为主，符合率为79．2％。肾脏病理的活动性与非活动性的尿沉渣谱类型分布的差异有统计学意义（P〈0．01）。（4）多因素分析结果显示尿沉渣谱改变是肾脏是否有活动性损伤的危险因素（P〈0．01）。结论IgA肾病的尿沉渣谱类型可反映肾病理损伤的活动性。尿沉渣谱检查方法简便、易行，可作为临床随诊的无创监测指标。Objective To investigate the relationship between urinary sediments and renal pathological patterns in IgA nephropathy. Methods A total of 516 specimens of fresh fasting morning urine were collected. Urinary specimens were processed routinely and examined with phasecontrast microscopy. Urinary sediments were classified into three types according to the components： type Ⅰ： hematuria containing dysmorphie red blood eells（RBCs）; type Ⅱ： active urinary sediments containing hematuria and casts of RBCs, and/or a few casts containing white blood cells or epithelial cells; type Ⅲ： advanced urinary sediments containing hematuria, and various casts consisted of red andwhite blood cells, renal tubular epithelial cells, and waxy casts. Pathological patterns of IgA nephropathy were classified according to the descriptive diagnosis of pathological lesions. Statistical analysis were performed using kappa test, X2 test, and significance was accepted at P 〈 0.05. Results The pathological patterns of 516 cases of IgA nephropathy included focal proliferative pattern in 75.2%, mesangial proliferative pattern in 7%, proliferative and sclerosing pattern in 6.8%, endocapillary proliferative pattern in 2.9%, crescentic pattern in 2.3% respectively. Hematuria was present in 74.8% （386/516 cases） of patients before renal biopsy, 15.7% of them had gross hematuria. Urinary sediments of 386 cases consisted of 54% of type Ⅰ, 35% of type Ⅱ, and 11% of type Ⅲ respectively. Type Ⅰ urinary sediment was present in focal proliferative pattern without active lesions, its concordance was 79.4%; while type Ⅱ were mainly seen in cases with glomerular and/or tubulointerstitial active lesions; type Ⅲ were seen in crescentic or endocapillary proliferative pattems and/or cases with active tubulointerstitial lesions. The concordance of type II and type m urinary sediments with active glomerular and tubulointerstitial lesions in IgA nephropathy was 79.2%. There was a significant difference in urinary sediment types betwee

关 键 词：IGA肾病 尿分析 活组织检查 肾 位相差显微镜 

分 类 号：R692[医药卫生—泌尿科学]