60例无症状性血尿和(或)蛋白尿患者的临床与病理分析研究  

Clinicopathological features of 60 cases of asymptomatic hematuria and/or proteinuria

作　　者：郭春花[1] 林冲云[1] GUO Chun-hua LIN Chong-yun.(Department of Nephrology , the Affiliated Longyan First Hospital of Fujian Medical University, Longyan 364000, Chin)

机构地区：[1]福建医科大学附属龙岩第一医院肾内科,龙岩364000

出　　处：《临床肾脏病杂志》2016年第9期535-538,共4页Journal Of Clinical Nephrology

摘　　要：目的分析无症状性血尿和(或)蛋白尿的临床与病理资料,探讨二者之间的关系。方法回顾性分析福建医科大学附属龙岩市第一医院肾内科60例无症状性血尿和(或)蛋白尿患者的临床资料,根据24 h尿蛋白定量水平是否大于150 mg,分为单纯血尿组(14例,其中男6例,女8例)与蛋白尿组(单纯蛋白尿或蛋白尿合并血尿46例,男18例,女28例)。根据肾脏病理免疫荧光检查有无IgA在肾小球系膜区沉积,分为IgA组(36例,男11例,女25例)与非IgA组(24例,男13例,女11例),分别进行2组间统计分析。结果与单纯血尿组比较,蛋白尿组病理类型偏重。单纯血尿组血尿酸水平为(305.5±90.8)μmol/L,蛋白尿组血尿酸水平为(376.7±86.7)μmol/L,2组间差异具有统计学意义(P=0.03),但2组间血肌酐、血清胱抑素C(cystatin C,Cys C)、血清IgA、补体C3等无统计学差异(P>0.05);非IgA组血肌酐水平为(59.2±14.8)μmol/L,IgA组血肌酐水平为(71.5±21.6)μmol/L,2组间差异具有统计学意义,但2组间Cys C、血尿酸、血清IgA、补体C3、24 h尿蛋白定量检查结果无统计学差异(P>0.05),且除了24 h尿蛋白定量外,其他上述检验结果均在日常检测参考值范围内。结论无症状性血尿和(或)蛋白尿的临床表现及其血肌酐、Cys C、血尿酸、血清IgA、补体C3、24 h尿蛋白定量检查结果对肾脏病理损伤的指示不敏感,肾穿刺活检行病理检查是金标准,但目前缺乏统一的评分体系,建立一个量化的涵盖临床及病理资料的无症状性血尿和(或)蛋白尿肾脏疾病评分体系,对实验和临床有特殊意义。Objective To investigate the clinicopathological features of asymptomatic hematuria and/or proteinuria. Methods The clinicopathological features were analyzed and correlated in 60 cases of asymptomatic hematuria and/or proteinuria. According to 24-h urine protein excretion 〉 150 mg, 60 cases were divided into simple hematuria group （n = 14, 6 males and 8 females） and proteinuria group（simple proteinuria or proteinuria with hematuria） （n = 46,18 males and 28 females）. The study population also was divided into IgA nephropathy group （n = 36, 11 males and 25 females） and non- IgA nephropathy group （n = 24, 13 males and 11 females） by mesangial IgA deposition, and the statistical analysis was carried out respectively. Results The pathological features in proteinuria group were more severe and serum uric acid was higher in proteinuria group than in simple hematuria group [（305. 5 ±90. 8） vs. （376. 7 ±86. 7）μmol/L, t = - 2. 27, P = 0. 033, showed statistical significant difference, but there were no differences in serum creatinine, Cystatin C（Cys C）, serum IgA and complement C3. The creatinine levels of IgA nephropathy group was higher than Non-IgA nephropathy [（71.5 ±21.6） vs. （59. 2 ±14. 8）μmol/L, t = 2. 09, P = 0. 043, but no differences in Cys C, serum uric acid, serum IgA. Complement C3 and 24-hour urinary protein. Moreover, except 24-hour urinary protein, all the values were within the normal range of reference values. Conclusions Renal lesion can not be sensitively marked by clinical features, such as serum creatinine, Cys C, serum uric acid, serum IgA, Complement C3, 24-hour urinary protein： renal biopsy is the criteria for diagnosis. So far, there is a lack of uniform scoring system to assess renal lesion.

关 键 词：血尿 蛋白尿 病理 

分 类 号：R696[医药卫生—泌尿科学]