高尿酸血症对IgA肾病临床病理特征和疾病进展的影响  

Effect of hyperuricemia on the clinicopathological features and progression of IgA nephropathy

作　　者：崔炯[1] 林矜 张小红[1] 万建新[1] CUI Jiong;LIN Jin;ZHANG Xiao-hong;WAN Jian-xin(Department of Nephrology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院肾内科

出　　处：《中国实用内科杂志》2019年第12期1073-1079,共7页Chinese Journal of Practical Internal Medicine

摘　　要：目的分析IgA肾病(IgA nephropathy,IgAN)伴高尿酸血症的临床和病理特征,并探讨高尿酸血症对IgAN进展的影响。方法以2006年1月至2016年12月福建医科大学附属第一医院行肾组织活检确诊为IgAN的患者为研究对象,根据血尿酸水平分为高尿酸血症组和尿酸正常组,比较分析两组患者临床和病理特征。以血肌酐倍增或进入终末期肾病(ESRD)或进入肾脏替代治疗为观察终点,用Kaplan-Meier法比较两组患者的肾脏生存率,并用逐步Cox回归模型分析影响IgAN进展的危险因素。结果进入终点事件或未进入观察终点但随访时间>2年的231例IgAN患者纳入研究,其中伴高尿酸血症组92例(39.8%),血尿酸正常组139例(60.2%)。两组在性别、血压、血肌酐、血尿素氮、24 h尿蛋白、估算的肾小球滤过率(eGFR)、病理分级、肾小管萎缩/间质纤维化程度方面差异有统计学意义(P<0.05)。29例进入终点事件,单因素COX回归分析显示肾小球硬化、肾小管萎缩/间质纤维化、24h尿蛋白定量、高尿酸血症、贫血、高血压病、血肌酐、血尿素氮在进展组与非进展组间差异有统计学意义(P<0.05);Kaplan-Meier生存曲线提示,IgAN伴高尿酸血症组肾脏存活率较低。逐步校正的多因素COX回归分析显示贫血、24 h尿蛋白、肾小球硬化、血肌酐是IgAN进展的独立危险因素。结论伴高尿酸血症的IgAN患者临床表现和肾脏病理损害更重,肾小管萎缩/肾间质纤维化程度更高,肾脏存活率更低。Objective To investigate the clinical and pathological features in hyperuricemic IgA nephropathy,and the effect of hyperuricemia on progression of IgAN.Methods Patients with IgAN confirmed by renal biopsy were enrolled.Those patients were admitted to the First Affiliated Hospital of Fujian Medical University from January 2006 to December 2016.The relationship between uric acid and clinical and pathological changes was analyzed.Patients were followed up and the level of serum creatinine was measured.Primary endpoint was double of creatinine or end-stage renal disease(ESRD)or renal replacement therapy.Risk factors of progression in IgAN were assessed using Kaplan-Meier and Cox proportional hazards analyses.Results A total of 231 patients with IgAN either reached the endpoint or followed up for more than 2 years were enrolled.Among these patients,the prevalence of hyperuricaemia was 39.8%.There were significant differences in gender,systolic blood pressure,diastolic blood pressure,serum creatinine,blood urea nitrogen,24-hour urine protein,eGFR,degree of tubule atrophy/interstitial fibrosis between high(H-UA)group and normal(N-UA)uric acid group(P<0.05).A total of29 patients reached the endpoint.Univariate COX regression analysis showed that there were significant differences between the progressive group and the non-progressive group in glomerulosclerosis,renal tubular atrophy/interstitial fibrosis,24-hour urine protein quantification,hyperuricemia,anemia,hypertension,blood creatinine,and blood urea nitrogen(P<0.05).Kaplan-Meier survival curve suggested that renal survival was lower in H-UA IgAN group.Anemia,24-hour urine protein,glomerulosclerosis,and serum creatinine are independent risk factors for progression of Ig AN assessed by multivariate analysis.Conclusion Hyperuricemia may be positively associated with severe clinical and pathological damage,more renal tubular atrophy/interstitial fibrosis lesions,and lower renal survival.

关 键 词：IGA肾病 高尿酸血症 临床病理学 预后 

分 类 号：R692.31[医药卫生—泌尿科学]