IgA肾病间质纤维化程度与临床指标及组织病理分型相关性分析  

Correlation of renal interstitial fibrosis degree with the clinical indicators and pathological classification in patients with IgA nephropathy

作　　者：查汗.索林格 李静[1] 桑晓红[1] Chahan SUOLINGE;LI Jing;SANG Xiao-hong(Department of Nephrology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Chin)

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2018年第6期536-540,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81660127)

摘　　要：目的探讨IgA肾病肾间质纤维化程度与临床指标及组织病理分型的相关性。方法 IgA肾病患者213例,根据组织病理牛津分型分为轻度肾间质纤维化组(间质纤维化≤25%)患者134例,中度肾间质纤维化组(间质纤维化>25%~50%)患者38例,重度肾间质纤维化组(间质纤维化>50%)患者41例。比较3组临床和肾脏组织病理学资料,采用ROC曲线分析估算肾小球滤过率对肾间质纤维化的预测作用,采用多因素logistic回归分析IgA肾病患者肾间质纤维化的影响因素,采用Spearman分析肾脏组织病理分型与IgA肾病肾间质纤维化程度的相关性。结果重度肾间质纤维化组24h尿蛋白定量、收缩压、舒张压、尿酸水平、24h尿蛋白定量≥3.5g发生率高于轻度肾间质纤维化组和中度肾间质纤维化组,中度肾间质纤维化组高于轻度肾间质纤维化组(P<0.05);重度肾间质纤维化组总胆固醇、估算肾小球滤过率、低密度脂蛋白胆固醇水平低于轻度肾间质纤维化组和中度肾间质纤维化组,中度肾间质纤维化组低于轻度肾间质纤维化组(P<0.05);估算肾小球滤过率预测肾脏间质纤维化的AUC为0.910±0.023(95%CI:0.865~0.955,P<0.001);重度肾间质纤维化组慢性肾脏病分期3、4、5期发生率(48.8%、26.8%、12.2%)和IgA+IgM+C3沉积比率(46.3%)高于中度肾间质纤维化组(15.8%、0、5.3%、39.5%)和轻度肾间质纤维化组(11.2%、0、0、17.9%),中度肾间质纤维化组高于轻度肾间质纤维化组(P<0.05):估算肾小球滤过率降低和24h尿蛋白定量增高是发生肾间质纤维化的独立危险因素(OR=1.957,95%CI:0.944~1.969,P<0.001;OR=2.255,95%CI:1.595~3.189,P<0.001),低密度脂蛋白胆固醇、收缩压、舒张压、尿酸、总胆固醇等指标对肾间质纤维化水平无明显影响(P>0.05);系膜细胞增生(r=0.386,P<0.001)、内皮细胞增生(r=0.300,P<0.001)、24h尿蛋白定量(r=0.348,P<0.001)、慢性肾脏病分期(r=0.567,P<0.001)与IgA肾病肾间质纤�Objective To explore the correlation of the degree of renal interstitial fibrosis with the clinical indicators and pathological classification in patients with IgA nephropathy.Methods Totally 213 patients with IgA nephropathy were divided into 134 patients with mild renal interstitial fibrosis（fibrosis degree≤25%）（mild group）,38 patients with moderate renal interstitial fibrosis（fibrosis degree〉25%-50%）（moderate group）,and 41 patients with severe renal interstitial fibrosis（fibrosis degree〉50%）（severe group）according to the Oxford Histopathologic Classification.The clinical and pathological data were compared among three groups.The role of the estimated glomerular filtration rate（eGFR）in predicting renal interstitial fibrosis was analyzed by ROC,the influencing l factors for renal interstitial fibrosis were analyzed by multivariable logistic regression analysis,and correlation of renal pathological classification with renal interstitial fibrosis degree was analyzed by Spearman method.Results In severe group,24 hurine protein quantitation,systolic blood pressure,diastolic blood pressure,uric acid level and 24 hurine protein≥ 3.5 g were significantly higher than those in mild group and moderate group（P〈0.05）,and in moderate group than those in mild group（P〈0.05）.The levels of total cholesterol,eGFR and low-density lipoprotein cholesterol（LDL-C）were significantly lower in severe group than those in mild group and moderate group,and in moderate group than those in mild group（P〈0.05）.The AUCof eGFR for predicting renal interstitial fibrosis was 0.910±0.023（95%CI：0.865-0.955,P〈0.001）.The incidences of chronic kidney disease（CKD）stage 3,4 and 5（48.8%,26.8%,12.2%）and IgA＋IgM＋C3 deposition ratio（46.3%）in severe group were significantly higher than those in moderate group（15.8%,0,5.3%,39.5%）and mild group（11.2%,0,0,17.9%）（P〈0.05）,and higher in moderate group than those in mild group（P〈0.05）.The low eGFR and high 24 hurine

关 键 词：IGA肾病 肾间质纤维化 肾脏组织病理分型 

分 类 号：R692.31[医药卫生—泌尿科学]