IgA肾病伴高血压患者临床病理改变特征及预后分析  

Analysis of the clinical pathological characteristics and prognosis of primary IgA nephropathy with hypertension

作　　者：刘泽洲 苏可[1] 杨定平[1] 刘红燕[1] 杨红霞[1] Liu Zezhou;Su Ke;Yang Dingping;Liu Hongyan;Yang Hongxia(Department of Nephrology,Renmin Hospital of WuHan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肾内科,武汉430060

出　　处：《中华肾脏病杂志》2019年第9期648-654,共7页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81670631).

摘　　要：目的探讨伴有高血压(HTN)的IgA肾病(IgAN)患者的临床病理改变特征及影响预后的危险因素。方法回顾性分析武汉大学人民医院2016年1月至2017年12月期间确诊的原发性IgAN患者的临床病理资料,依据肾活检时是否合并HTN分为IgAN血压正常(IgAN-NTN)组和IgAN伴高血压(IgAN-HTN)组,比较两组患者临床病理改变的差异。采用Kaplan-Meier生存曲线评估患者肾脏累积生存率,Cox回归模型法分析影响IgAN-HTN患者肾脏进展的危险因素。结果共纳入275例IgAN患者,其中IgAN-NTN组170例(61.82%),IgAN-HTN组105例(38.18%)。IgAN-HTN组在男性占比、年龄、收缩压、舒张压、血尿素氮、血肌酐、血尿酸、24 h尿蛋白量、血三酰甘油、血清IgM、补体C4等项目的水平高于IgAN-NTN组(均P<0.05);肉眼血尿发生率及估算肾小球滤过率(eGFR)显著低于NTN组(均P<0.001)。光镜下IgAN-HTN组球性硬化、肾小管萎缩/肾间质纤维化占比、间质血管损伤程度高于IgAN-NTN组(均P<0.05);免疫荧光检查结果显示,IgAN-HTN组C1q沉积占比高于IgAN-NTN组(P=0.015)。Kaplan-Meier生存曲线分析结果显示,IgAN-HTN组肾脏累积生存率明显低于IgAN-NTN组(Log-rank检验χ^2=6.456,P=0.011);IgAN-HTN患者中,血脂异常组肾脏累积生存率低于血脂正常组(Log-rank检验χ^2=5.093,P=0.024);血压控制达标组与未达标组肾脏累积生存率的差异无统计学意义(Log-rank检验χ^2=1.036,P=0.309)。单因素和多因素Cox回归分析结果显示,血总胆固醇、eGFR、24 h尿蛋白量为IgAN-HTN患者发生终点事件的危险因素。结论IgAN-HTN患者临床表现及肾脏病理改变较IgAN-NTN患者严重,肾脏预后较差。应重视IgAN-HTN患者治疗及随访过程中的血脂管理。Objective To investigate the clinic-pathological features and prognostic risk factors of IgA nephropathy (IgAN) with hypertension (HTN). Methods Primary IgAN patients diagnosed with biopsy from January 2016 to December 2017 were recruited. Patients were divided into IgAN with normal blood pressure (IgAN-NTN) group and IgAN with hypertension (IgAN-HTN) group based on the pressure value when performing the kidney biopsy. The clinical and pathological data were collected and compared between the two groups. Kaplan-Meier method was conducted for renal results, whereas the Cox regression model was exploited to analyze the prognostic factors in the progression of IgAN-HTN patients. Results The total number of enrolled patients was 275 cases, 170 (61.82%) of which had normal pressure and 105 individuals (38.18%) resulted in hypertension. The IgAN-HTN group in terms of male proportion, age, systolic pressure, diastolic pressure, serum urea nitrogen, serum creatinine, serum uric acid, 24 h urinary protein, triacylglycerol, complement C4 and so on were higher than those in the IgAN-NTN group (all P<0.05). The incidence of gross hematuria and the level of estimated glomerular filtration rate (eGFR) were significantly lower than those in the NTN group (all P<0.001). For the aspect of light microscope pathological manifestations, IgAN-HTN group exhibited more severe histological lesions including glomerular sclerosis, renal tubular atrophy or renal interstitial fibrosis, interstitial vascular injury than IgAN-NTN group (all P<0.05). Immunofluorescence examination results showed that the deposition ratio of C1q in IgAN-HTN group was higher than that in IgAN-NTN group (P=0.015). By employing Kaplan-Meier method, the cumulative renal survival rate in the HTN group was much lower than that in the NTN group (Log-rank test:χ^2=6.456, P=0.011). For the patients in IgAN-HTN group, the cumulative renal survival rate in the dyslipidemia group was much lower than that in the ortholiposis group (Log-rank test:χ^2=5.093, P=0.024). There

关 键 词：肾小球肾炎 IgA 高血压 血脂异常 临床 预后 

分 类 号：R692.31[医药卫生—泌尿科学] R544.1[医药卫生—外科学]