肾小管胆固醇结晶对IgA肾病预后的影响  

Association of cholesterol crystals in renal tubular lumen and prognosis in patients with IgA nephropathy

作　　者：吴丹[1,2] 梁少姗 徐峰 梁丹丹 李溪玥 朱莹 汤雯 杨帆 曾彩虹 WU Dan;LIANG Shaoshan;XU Feng;LIANG Dandan;LI Xiyue;ZHU Ying;TANG Wen;YANG Fan;ZENG Caihong(Southeast University School of Medicine,Nanjing 210009,China;National Clinical Research Center of Kidney Diseases,Jinling Hospital,Southeast University School of Medicine,Nanjing 210009,China;Pathology Department,Zhejiang University School of Medicine Sir Run Run Shaw Hospital,Hangzhou 310000,China)

机构地区：[1]东南大学医学院,南京210009 [2]东部战区总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所 [3]浙江大学附属邵逸夫医院病理科

出　　处：《肾脏病与透析肾移植杂志》2020年第4期317-322,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金面上项目(81570644);江苏省卫计委“科教强卫”项目(ZDRCA2016098)。

摘　　要：目的:明确合并肾小管胆固醇结晶(cholesterol crystals,CCs)的IgA肾病(IgA nephropathy,IgAN)患者的临床病理及预后特征。方法:2019年3月~2019年12月自体肾活检常规阅片5025例,计算CCs在各肾脏疾病中发生率。调阅2006~2010年及2018~2019年经肾活检明确为IgAN的3784例患者切片,147例患者肾小管内见CCs,对照组由同期446例不伴肾小管CCs的IgAN患者组成。收集临床、病理及随访资料。结果:自体肾活检肾小管CCs发生率为0.68%(34/5025),IgAN肾小管CCs的发生率为1.45%(25/1718)。伴肾小管CCs的IgAN患者男性多见,病程短,血白蛋白低,血清肌酐、总胆固醇、三酰甘油、尿酸、尿蛋白更高;系膜增殖、节段硬化和小管间质损伤更重。肾脏存活率低于对照组(P<0.001)。多因素COX回归模型分析发现,存在肾小管CCs、高胆固醇血症、肾活检时肾功能受损是影响IgAN肾脏预后的独立危险因素。结论:IgAN中肾小管CCs的发生率高于其他疾病,伴肾小管CCs的IgAN临床病理表现重,进入终末期肾病风险增高。Objective:To investigate the incidence of cholesterol crystals(CCs)in renal tubular lumen in IgA nephropathy(IgAN),and the effect of CCs in renal tubular lumen on the prognosis of IgAN.Methodology:A total of 5025 native renal biopsies were observed routinely from Mar.2019 to Dec.2019 for the incidence of CCs.3784 IgAN patients from 2006 to 2010 and 2018⁃2019 were retrospectively observed,and 147 patients with CCs in renal tubular lumen were finally included in the study.The control group comprised of 446 patients of IgAN without CCs.Clinical,pathological and prognosis of the patients were collected and analyzed.Results:The total incidence of renal tubular lumen CCs in different renal diseases was 0.68%(34/5025).The incidence of renal tubular lumen CCs in IgAN was 1.45%(25/1718).The level of urine protein,serum creatinine,total cholesterol,triglyceride,uric acid in study group were all higher than those in control group.Mesangial proliferation,segmental sclerosis,and tubulointerstitial damage in study group were more severe than those in control group.Survival analysis showed that renal prognosis of study group was significantly worse than that of control group(P<0.001).Multivariate COX regression model analysis found that presence of CCs,hypercholesterolemia,and impaired renal function at the time of biopsy were independent risk factors for renal prognosis in patients with IgAN.Conclusion:The incidence of CCs in renal tubular lumen in IgAN is higher than other kidney diseases.The clinical and pathological manifestations of IgAN with CCs were more severe,and prognosis was poorer than those without CCs.

关 键 词：IGA 肾病 结晶型肾病 胆固醇结晶 

分 类 号：R692.31[医药卫生—泌尿科学]