脊柱关节炎继发IgA肾病的临床与病理特点  

Analysis on Clinical and Pathological Characteristics of IgA Nephropathy Secondary to Spondyloarthritis

作　　者：张广莉[1] 吴燕[1] 薛勤[1] 汪年松[1] ZHANG Guangli;WU Yan;XUE Qin(Department of Nephrology,Shanghai Jiaotong University Affiliated Sixth People's Hospital,Shanghai,200233)

机构地区：[1]上海交通大学附属第六人民医院肾脏内科,上海200233

出　　处：《中国中西医结合肾病杂志》2018年第11期955-959,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家自然基金面上项目(No.81400735;81670657);上海交通大学转化医学创新基金资助项目(No.152H2011);上海市徐汇区重点项目(No.SHXH201648);上海市综合医院中西医结合专项项目(No.ZHYY-ZXYJHZX-201608)

摘　　要：目的:探讨脊柱关节炎继发IgA肾病患者的临床、病理特点。方法:回顾性分析2010年01月～2017年01月上海市第六人民医院肾脏内科收治的17例脊柱关节炎继发IgAN患者的临床表现、实验室检查、病理特点、治疗与转归。结果:17例SpA患者中,男13例,女4例,肾活检时年龄为(33. 2±9. 1)岁,15例患者(88. 2%)为HLA-B27阳性,17例患者有蛋白尿,15例患者有蛋白尿合并血尿,1例患者有肾功能不全;肾活检病理中,所有患者均有系膜细胞增生,10例患者(58. 8%)有肾小球球性硬化,其中7例患者(41. 2%)肾小球球性硬化比例> 10%,9例患者(52. 9%)有肾小管萎缩,3例患者(17. 6%)有新月体形成,3例患者(17. 6%)有球囊粘连,3例患者(17. 6%)有肾间质纤维化,肾间质血管病变8例(47. 1%)。除3例失访患者外,大部分患者蛋白尿和血尿缓解或稳定,所有患者肾功能基本保持稳定。结论:脊柱关节炎继发IgAN临床起病隐匿,常表现为血尿及蛋白尿。病理中新月体、球囊粘连均发生在骶髂关节炎≥3级患者,肾小球球性硬化及间质炎性细胞浸润较多见。通过肾穿刺活检可明确病理分型并有助于制定合适的治疗方案,预后较好。Objective: To investigate the clinical and pathological characteristics of patients with IgA nephropathy secondary to spondyloarthritis. Methods: A retrospective study was performed based on the clinical manifestations,laboratory tests,pathological characteristics,therapeutic regimens and follow-up of 17 patients diagnosed with IgA nephropathy secondary to spondyloarthritis by renal biopsy from January 2010 to January 2017. Results: The cohort of 17 patients included 13 men and 4 women. The age of renal biopsy was 33. 2 ± 9. 1 years old. Fifteen patients( 88. 2%) presented HLA-B27 gene positive. Seventeen patients had proteinuria,15 patients had proteinuria complicated with hematuria,and 1 patient had renal impairment. Biopsies revealed mesangial proliferation in 17 patients( 100%). They showed following patterns: 10 patients( 58. 8%) with glomerular sclerosis,7 patients( 41. 2%)showed glomerular sclerosis > 10%,9( 52. 9%) with renal tubular atrophy,3( 17. 6%) with crescent formation,3( 17. 6%) with capsular synechia,3( 17. 6%) with renal interstitial fibrosis,and 8( 47. 1%) interstitial vascular lesion. In this group of patients,except the 3 patients lost to follow-up,most patients’ clinical symptoms remained stable or relieving,and only 1 patient had aggravated proteinuria and hematuria,the renal function of all patients remained stable. Conclusion: IgA Nephropathy Secondary to SpA can be clinically manifested as asymptomatic hematuria and proteinuria. Compared to patients with sacroiliac arthritis < grade 3,all3 cases of crescent formation,capsular synechia and renal interstitial fibrosis occurred only in the patients with sacroiliac arthritis grade 3. Renal biopsy can determine pathological classification and help to make appropriate therapeutic regimen,leading to better prognosis.

关 键 词：脊柱关节炎 继发性IgA肾病 临床 肾脏病理 

分 类 号：R593.2[医药卫生—内科学] R692.31[医药卫生—临床医学]