无症状性血尿患者肾脏病理变化和临床特点分析  

Analysis of renal pathological changes and clinical characteristics in patients with asymptomatic hematuria

作　　者：林冲云[1] 林峥[1] 郭春花[1] 许春梅[1] 

机构地区：[1]福建医科大学附属龙岩市第一医院肾内科

出　　处：《临床肾脏病杂志》2015年第12期725-728,共4页Journal Of Clinical Nephrology

摘　　要：目的了解无症状性血尿患者肾脏病理改变及其与临床的关系。方法选择2013年1月至2015年5月福建医科大学附属龙岩市第一医院肾内科经肾活检病理诊断的无症状性血尿患者60例，并根据肾活检病理结果将其分为IgA肾病组和非IgA肾病组，比较2组患者病理改变与临床指标（尿红细胞、血胆固醇、收缩压、舒张压、24h尿蛋白定量、血肌酐、血白蛋白、血尿酸、估算肾小球滤过率、血红蛋白、纤维蛋白原、血清IgA、血清IgG、IgM等），应用Logistic回归分析和受试者工作特征性曲线（receiver operating characteristic curves，ROC）探讨IgA肾病独立预测因素。结果60例患者中IgA肾病36例（占60．0％），非IgA肾病24例（占40．0％，其中系膜增生性肾小球肾炎12例，微小病变4例，膜性肾病3例，局灶增生型紫癜性肾炎2例，局灶节段性肾小球硬化症1例，乙肝病毒相关性膜性肾病1例，急性肾小管间质损伤1例）。IgA肾病组肾小球病理损伤评分明显高于非IgA肾病组（P〈0．05）；二分类Logistic回归分析提示血清IgA水平是预测无症状性血尿患者发生IgA肾病的独立预测因子EP=0．039，OR=1．909，95％CI（1．0343．525）]，ROC显示曲线下面积（area under curve，AUC）为0．703[95％CI（0．547-0．859）]，最佳切点值为1．775g／L。结论无症状性血尿患者病理类型以IgA肾病为主，临床表现与病理损伤程度并不完全一致。IgA肾病患者肾小球病变更明显，肾活检有助于诊断和预后评估。血清IgA水平可能是预测kA肾病发生的独立预测因素。Objective To investigate the renal pathological changes in patients with asymptomatie hematuria and the relationship between renal pathological changes and clinical manifestation. Methods 60 patients with asyrnptomatic hematuria who underwent renal biopsy were selected and their renal pathological changes were analyzed. We used Logistic regression analysis and ROC curve to investigate the independent predictor of IgA nephropathy. Results The pathologic findings in 60 patients were as follow： 36 cases were IgA nephropathy（60%）, 24 cases were non-IgA nephropathy （40%, including 20 eases of mesangial proliferative glomerulonephritis, 4 cases of minor glomerulonephritis change, 3 cases of membranous nephropathy, 2 cases of focal hyperplasia purpura nephritis, a ease of focal segmental glomerulonephritis, a case of hepatitis B related membranous nephropathy, and a ease of acute renal tubular interstitial injury）. The glomerular pathological damage score of IgAN group was significantly higher than that of non-IgAN group （P〈0. 05）. The result of binary Logistic regression analysis shows that serum IgA level was the independent predictor of IgA nephropathy in patients with asymptomatic hematuria（P = 0. 039, odds ratio[OR] = 1. 909, 95% confidence interval [-CI]： 1. 034 to 3. 525）. The ROC（receiver operating characteristic curves） shows that the AUC（area under curve） is 0. 073（95% CI 0. 547-0. 859） and the outpoint is 1. 775 g/L. Conclusions The main pathological types of patients with asymptomatic hematuria is IgA nephropathy. The clinical manifestations and pathological changes of these patients were not completely consistent. Glomerular lesions in patients with IgA nephropathy were more obvious. Renal biopsy is helpful for the diagnosis and prognosis of these patients. Serum IgA level may be an independent predictor of IgA nephropathy.

关 键 词：血尿 肾活检 IGA肾病 

分 类 号：R696.8[医药卫生—泌尿科学]