病史中伴有肉眼血尿的IgA肾病患者临床和病理特征分析  

Clinical and pathological features of IgA nephropathy with macrohematuria in history

作　　者：袁梦[1] 刘文婷[1] 周倩[1] 张望[1] 杨琼琼[1] 陈崴[1] 余学清[1] 

机构地区：[1]中山大学附属第一医院肾内科卫生部和广东省肾脏病临床重点实验室,广州510080

出　　处：《中华肾脏病杂志》2015年第6期401-407,共7页Chinese Journal of Nephrology

基　　金：“十二五”国家科技支撑计划（2011BA110805）;中山大学5010项目（2007007）

摘　　要：目的 探讨IgA肾病（IgAN）病史中伴发肉眼血尿患者的临床及病理特征.方法 回顾性分析2006年1月至2011年12月于中山大学附属第一医院经肾活检确诊的IgAN患者,比较肾活检前伴或不伴肉眼血尿发作（肉眼血尿组和对照组）的两组患者临床及病理特征,并将肉眼血尿组按肉眼血尿发作距离肾活检时间分为3组,分析比较以探讨近期肉眼血尿发作患者伴随的临床及肾脏病理特征.结果 研究纳入的1512例IgAN患者中,病史伴发肉眼血尿的比例为22.1％.肉眼血尿组血肌酐水平、24 h尿蛋白排泄量及高血压发生率均低于对照组（均P＜ 0.001）,镜下血尿程度更重（P＜0.001）,两组间病程差异无统计学意义（P=0.627）.病理方面,肉眼血尿组的慢性指标,如球性/节段硬化、肾小管萎缩/间质纤维化程度等均低于对照组（均P＜ 0.001）,但活动性指标,如新月体比例（P=0.024）、袢坏死比例（P=0.001）及系膜增生程度（P=0.026）均高于对照组.肉眼血尿发作1个月内行肾穿刺活检的患者伴更大量蛋白尿（P=0.010）及镜下血尿（P＜0.001）,病理上内皮细胞增生、袢坏死及新月体形成的比例均更高（均P＜ 0.05）.结论 病史中伴有肉眼血尿的IgAN患者临床及病理慢性改变较轻,病理活动性病变更明显,特别是在1个月内发生肉眼血尿患者中更为突出.Objective To investigate the clinical and pathological characteristics of IgA nephropathy （IgAN） with macrohematuria （MH）.Method 1512 consecutive patients with biopsyproven IgAN diagnosed from January 2006 to December 2011 were enrolled,and divided into MH group and control group respectively,according to whether there existed episodes of MH before renal biopsy.The clinical and pathological characteristics were compared between two groups.Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH.Results The rate of MH in history was 22.1%.MH group patients had significantly lower serum creatinine,slighter proteinuria,lower prevalence of hypertension and heavier microhematuria than control group （all P 〈 0.001）.The prebiopsy durations were similar in two groups （P=0.627）.In MH group,chronic pathological indicators,including global/segmental sclerosis,tubule atrophy/interstitial fibrosis were all slighter （all P〈 0.001）,whereas activity indicators,including necrosis lesions,crescents and mesangial proliferation were all more severe compared with control group （all P 〈 0.05）.Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria,higher prevalence of necrosis lesions,more severe crescents formation,and endothelial proliferation （all P 〈 0.05）.Conclusions IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations,however more active pathological changes especially in those who suffer episode of MH recently.

关 键 词：IGA肾病 血尿 病理学 临床 新月体 袢坏死 

分 类 号：R692.31[医药卫生—泌尿科学]