肾活检时高尿酸血症与IgA肾病临床及牛津病理相关性研究  

Correlation between hyperuricemia and clinical and Oxford pathology of IgA nephropathy on renal biopsy

作　　者：鲁珍珍 邓跃毅[1] 刘旺意 Lu Zhenzhen;Deng Yueyi;Liu Wangyi(Dept of Nephrology,Longhua Hospital Afiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032)

机构地区：[1]上海中医药大学附属龙华医院肾内科,上海200032

出　　处：《安徽医科大学学报》2020年第3期456-460,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家科技支撑计划项目(编号:2015BAI12B06);国家自然科学基金(编号:81573891)。

摘　　要：目的探讨肾活检高尿酸血症(HUA)与IgA肾病临床特征及牛津病理分型的相关性。方法回顾性分析经肾活检确诊为原发性IgA肾病患者289例,根据肾活检时尿酸水平分为高尿酸组120例,尿酸正常组169例,收集肾活检时临床及牛津病理资料,分析HUA与临床及牛津病理相关性。结果289例IgA肾病患者肾活检时HUA的发病率为41.5%,相较于尿酸正常组,高尿酸组的高血压发生率更高,肌酐、尿素氮、24 h尿蛋白水平更高,三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白等脂代谢更为异常。Spearman相关分析显示血尿酸与牛津病理分型中系膜增生(r=0.254,P<0.0001)、小球节段硬化(r=0.145,P=0.013)以及肾小管萎缩或间质纤维化(r=0.315,P<0.0001)相关。多因素Logistic回归对其他临床指标进行调整后显示HUA是系膜增生和小球节段硬化的独立危险因素。结合不同临床指标分别建立3个模型,采用ROC曲线联合诊断显示,尿酸可提高对系膜增生和小球节段硬化的诊断能力,且联合指标越多,诊断效能越大。结论肾活检时HUA与IgA肾病肾功能异常及脂代谢紊乱相关。同时,HUA与肾脏病理损伤有关,肾活检时HUA作为系膜增生和小球硬化的独立危险因素,可以提高对IgA肾病系膜增生和小球硬化的诊断价值。Objective To investigate the correlation between hyperuricemia and clinical features and Oxford pathology classification of IgA nephropathy on renal biopsy.Methods A retrospective analysis was performed on 289 patients diagnosed of primary IgA nephropathy by renal biopsy.According to the level of uric acid on renal biopsy,the patients were divided into two groups including 120 patients in the high uric acid group and 169 patients in the normal uric acid group.Clinical and histopathological data were collected to analyze the relationship between hyperuricemia and clinical features and Oxford classification on renal biopsy.Results The incidence of hyperuricemia in the 289 patients with IgA nephropathy was 41.5%on renal biopsy.Compared with the normal uric acid group,the high uric acid group had a higher incidence of hypertension.The levels of creatinine,urea nitrogen and 24-hour urinary protein were higher and the lipid metabolisms of triglyceride,cholesterol,high-density lipoprotein and low-density lipoprotein were more abnormal in the high uric acid group.Spearman correlation analysis showed that uric acid was closely related to mesangial proliferation(r=0.254,P<0.0001),glomerular segmental sclerosis(r=0.145,P=0.013)and tubular atrophy or interstitial fibrosis(r=0.315,P<0.0001).Multivariate logistic regression showed that hyperuricemia was an independent risk factor for mesangial proliferation and glomerular segmental sclerosis after adjustment of other clinical indicators.Three different models were established based on different clinical indicators.ROC curve combined diagnosis revealed that uric acid could improve the diagnostic ability of mesangial proliferation and glomerular segmental sclerosis.The more combined indicators,the greater the diagnostic efficiency.Conclusion Hyperuricemia is closely related to renal dysfunction and lipid metabolism disorder in IgA nephropathy on renal biopsy.At the same time,hyperuricemia is associated with renal pathological injury.As an independent risk factor for mesangial pr

关 键 词：IgA肾病 高尿酸血症 牛津病理 系膜增生 小球节段硬化 

分 类 号：R692.3[医药卫生—泌尿科学]