成人轻微尿检异常IgA肾病患者的临床与病理分析  

Clinicopathological analysis on adult IgA nephropathy patients with mild urinary abnormalities

作　　者：刘付捷[1] 许仕超[2] 张华丽[2] 陶静莉[3] 罗勉娜[3] 刘伟敬[3] 

机构地区：[1]广东医学院第二附属医院肾病内科,湛江524003 [2]广东医学院附属医院肾病内科中心,湛江524001 [3]广东医学院肾病研究所,湛江524001

出　　处：《临床肾脏病杂志》2015年第4期222-225,共4页Journal Of Clinical Nephrology

基　　金：湛江市科技攻关项目(2013B01296);广东医学院科研基金面上项目(M2013037)

摘　　要：目的临床怀疑为IgA肾病的轻微尿检异常患者是否需要肾活检一直有争议，本研究通过分析轻微尿检异常的IgA肾病患者临床表现与病理表现之间是否存在相关性，旨在进一步探讨肾活检对单纯轻微尿检异常IgA肾病患者的临床意义。方法临床表现为单纯轻微尿检异常且肾活检明确诊断的患者91例中，筛选达到明确病理诊断标准的患者77例，其中病理确诊为IgA肾病的患者53例，依其临床表现不同分为蛋白尿合并血尿组、单纯血尿组和单纯蛋白尿组，并采用Lee分级和牛津分类两种IgA肾病病理评估方法对其肾脏病理严重程度进行评价，且分别评价三种不同临床表现IgA肾病患者之间肾脏病理严重程度评分分布有无不同。结果77例明确病理诊断标准的患者中，被诊断为IgA肾病患者53例（占68．8％），其中蛋白尿并血尿者39例（占73．6％），单纯血尿者5例（占9．4％），单纯蛋白尿者9例（占17．0％）；53例轻微尿检异常IgA肾病患者中，病理分级以LeeⅢ级为最多（29例，占54．7％），其他依次为Ⅱ级（14例，占26．4％）和Ⅰ级（5例，占9．4％），而病变严重的Ⅳ级和Ⅴ级，分别为2例（占3．8％）和3例（占5．7％）；不同临床表现IgA肾病患者之间肾脏病理无论Lee分级还是牛津分布均无统计学差异（均P〉0．05）。结论鉴于临床表现不能作为鉴别肾脏病变轻重的依据，因此，怀疑IgA肾病的单纯尿检异常患者，应在无禁忌症的前提下尽可能行肾活检以明确诊断，以利于及时调整治疗方案。Objective Mild urinary abnormalities are very common in clinical practice, and IgA nephropathy is the most common reason of mild urinary abnormalities in adults. Whether the patients are necessary to receive renal biopsy was controversial. In order to clarify this issue, the clinical significance of renal biopsy in mild urinary abnormalities in patients with IgA nephropathy was investigated. Methods Fifty-three patients with IgA nephropathy were selected from 77 patients with mild urinary abnormalities whose renal pathological diagnosis was confirmed. The 53 patients with IgA nephropathy were divided into there group, including proteinuria with single microscopic hematuria group, single microscopic hematuria group and single proteinuria group, according to their clinical manifestations. Renal pathological severity of the 53 patients was also evaluated using the Lee＇s classification and the Oxford classification of IgA nephropathy. Whether the pathological classification of IgA nephropathy was different among three clinical manifestations was analyzed at last. Results Renal pathological diagnosis of 77 patients could be confirmed in 91 patients with mild urinary abnormalities who received renal biopsy. There were 53 （68. 8%） cases of IgA nephropathy, including 39 patients （73. 6%） with proteinuria in single microscopic hernaturia group, 5 patients （9. 4%） in single microscopic hematuria group and 9 （17. 0%） in single proteinuria group. According to Lee＇s pathological classification, Lee＇s class Ⅲ was the most common classification, counting for 54. 7% （29 patients）, followed by class Ⅱ （14 patients, 26. 4%） and class Ⅰ （5 patients, 9. 4%）. However, the severe grades, class Ⅳ and classV, accounted for 3. 8% （2 patients） and 5.7% （3 patients） respectively. There was no significant difference in the Lees classification and the Oxford classification among three groups with different clinical manifestations （P〈0. 05 for all）. Conclusions Different clinical manifes

关 键 词：IGA肾病 病理分级 Lee分级 

分 类 号：R692[医药卫生—泌尿科学]