IgA肾病合并高尿酸血症患者的临床和病理学分析  

Risk factors of hyperuricemia in patients with IgA nephropathy

作　　者：赵曼均 金济福 章晓燕[1] 沈子妍[1] 张函[1] 於佳炜[1] 丁小强[1] 

机构地区：[1]复旦大学附属中山医院肾内科,上海市肾病与透析研究所,上海市肾脏疾病与血液净化重点实验室,上海200032

出　　处：《上海医学》2016年第5期265-271,共7页Shanghai Medical Journal

基　　金：科技部国家科技支撑项目(2011BAI10B03);上海市科学技术委员会自然科学基金(14ZR1406400)资助

摘　　要：目的分析IgA肾病合并高尿酸血症患者的临床和病理学特征，探讨IgA肾病患者发生高尿酸血症的危险因素。方法回顾性分析2005年1月-2013年9月在复旦大学附属中山医院经肾脏活组织病理学检查确诊的1261例原发性IgA。肾病患者的临床和病理学资料，将患者分为高尿酸血症组（464例）和非高尿酸血症组（797例），比较两组患者的临床和病理学资料，并行Logistic回归分析与高尿酸血症发生有关的危险因素。结果高尿酸血症组男性患者构成比、年龄、有高血压病史患者构成比、BMI、收缩压、舒张压，血清尿素氮、血清肌酐、血清尿素、血清钾、血清磷、血清氯、空腹血糖、总胆固醇、三酰甘油、脂蛋白a、高敏C反应蛋白水平、红细胞沉降率、24h尿蛋白定量均显著高于非高尿酸血症组（P值分N〈0．01、0．05）；有肉眼血尿史患者构成比，血红蛋白、总蛋白、白蛋白、高密度脂蛋白胆固醇、免疫球蛋白M水平，镜下尿红细胞（＋＋＋）、（＋＋＋＋）患者的构成比，以及eGFR和二氧化碳结合力均显著低于非高尿酸血症组（P值分别〈0．01、0．05）。高尿酸血症组免疫荧光IgA染色强度（＋＋＋）、（＋＋＋＋）患者的构成比均显著低于非高尿酸血症组（P值均〈0．01），高尿酸血症组Lee分级Ⅳ和V级患者的构成比、球形硬化百分数，以及重度系膜细胞增生、系膜基质增多、肾间质纤维化、肾小管萎缩、间质炎性细胞浸润和血管病变患者的构成比均显著高于非高尿酸血症组（P值均〈O．01）。单因素Logistic回归分析显示，性别（0R—1．651，95％CI为1．014～1．033）、年龄（OR＝1．024，95％Cf为1．014～1．033）、肉眼血尿史（oR＝0．413，95％CI为0．300～0．568）、高血压病史（OR＝3．187，95％CI为2．509～4．046）、血红蛋白（OR＝0．991，95％CI为0．985～0．997）、白蛋Objective To explore clinicopathological characteristics and risk factors of hyperuricemia in patients with IgA nephropathy （IgAN）. Methods A total of 1 261 biopsy-proven primary IgAN patients in Zhongshan Hospital were recruited in this study from January 2005 to September 2013 They were divided into hyperuricemia group （n = 464） and non-hyperuricemia group （n = 797）. Clinical and pathological data were retrospectively analyzed. Logistic regressive analysis was used to evaluate risk factors related to hyperuricemia. Results The male constitute ratio, age, incidence of hypertension, body mass index （BMI）, systolic blood pressure, diastolic blood pressure, serum urea nitrogen, serum creatinine, serum urea, serum potassium, serum phosphorus, serum chlorine, fasting blood glucose, total cholesterol, triglyceride, lipid protein a, high-sensitivity C-reactive protein （CRP）, erythrocyte sedimentation rate, and 24-hour urinary protein in hyperuricemia group were significantly higher than those in non-hyperuricemia group （ P 〈 0. 01 or 0. 05）, but the ratio of gross hematuria,the levels of hemoglobin, total protein, albumin, high density fat cholesterol, immunoglobulin protein M, microscopic hematuria, estimated glomerular filtration rate（eGFR）, carbon dioxide binding force and the ratio of immunofluorescence intensity of IgA staining （ ＋ ＋ ＋ ） and （ ＋ ＋ ＋ ＋ ） in hyperuricemia group were significantly lower than those in the non-hyperuricemia group （P 〈 0. 01 or 0. 05）. Lee grading, percentage of glomerulosclerosis, the proportion of severe mesangial matrix hyperplasia, severe mesangial cell proliferation, severe renal interstitial fibrosis, severe renal tubular atrophy, severe interstitial infiltration of inflammatory cells, and severe vascular lesions in hyperuricemia group were significantly higher than those in non-hyperuricemia group （all P〈0.01）. Univariate logistic regression analysis showed that sex （OR = 1. 651, 95% CI： 1. 014 - 1. 033）, age �

关 键 词：高尿酸血症 IGA肾病 临床和病理学特征 

分 类 号：R692.31[医药卫生—泌尿科学] R589.7[医药卫生—外科学]