伴肾小动脉硬化病变的IgA肾病的临床病理特点及预后  

Clinicopathological features and prognosis of IgA nephropathy with renal arteriolosclerosis

作　　者：郭唯一 安秀平 孙丽君[1] 董鸿瑞[1] 徐潇漪[1] 程文荣 王国勤[1] 叶楠[1] 赵智睿 程虹[1] Guo Weiyi;An Xiuping;Sun Lijun;Dong Hongrui;Xu Xiaoyi;Cheng Wenrong;Wang Guoqin;Ye Nan;Zhao Zhirui;Cheng Hong(Department of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院肾内科,北京100029

出　　处：《中华肾脏病杂志》2023年第3期209-214,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金青年项目(81900653);首都卫生发展科研专项(首发2022-2-2066);北京市自然科学基金青年项目(7194258)。

摘　　要：该研究为回顾性研究, 分析2010年3月至2021年3月首都医科大学附属北京安贞医院866例IgA肾病(IgA nephropathy, IgAN)患者的临床资料, 探讨伴肾小动脉硬化病变的IgAN患者的临床病理及肾脏预后, 并初步探讨补体异常活化是否参与IgAN肾小动脉硬化病变的损伤。根据肾组织病理有无肾小动脉硬化病变分为肾小动脉硬化病变组和无肾小动脉硬化病变组, 比较两组间临床病理表现及预后。结果显示, 与无肾小动脉硬化病变组(n=236)相比, 肾小动脉硬化病变组(n=630)IgAN患者具有较高比例的高血压病史及恶性高血压病史, 较高水平的尿白蛋白肌酐比值、24 h尿蛋白量及血尿酸, 较低的估算肾小球滤过率, 较严重的牛津分型MEST-C病变(均P < 0.05)。Cox回归分析结果显示, 肾小动脉硬化病变是IgAN进展至主要终点事件(终末期肾病、估算肾小球滤过率下降≥30%或全因死亡)的独立影响因素(HR=6.437, 95%CI 2.013~20.585, P=0.002)。肾组织病理显示肾小动脉硬化病变组(n=98)IgAN患者的肾小动脉壁补体C3c沉积强度高于无肾小动脉硬化病变组(n=18, P < 0.05)。伴肾小动脉硬化病变的IgAN患者具有较为严重的临床病理表现及预后。补体系统的异常活化可能参与了IgAN的肾小动脉硬化病变的损伤过程。The study was a retrospective study.The clinical data of 866 patients with IgA nephropathy(IgAN)in Beijing Anzhen Hospital,Capital Medical University from March 2010 to March 2021 were analyzed,to investigate the clinical pathology and renal prognosis of IgAN patients with intrarenal arteriolosclerosis,and to preliminarily explore whether abnormal activation of complement system is involved in the injury of arteriolosclerosis.The patients were divided into renal arteriolar lesions group and non-renal arteriolar lesions group according to the renal histopathology,and the differences of clinical pathological manifestations,prognosis between the two groups were compared.The results showed that,compared with the non-renal arteriolar lesions group(n=236),IgAN patients in the renal arteriolar lesions group(n=630)had higher proportions of hypertension and malignant hypertension,higher levels of urinary albumin-creatinine ratio,24-hour urine protein quantification and serum uric acid,lower estimated glomerular filtration rate,and more severe MEST-C lesions of the Oxford classification(all P<0.05).Cox regression analysis results showed that intrarenal arteriolosclerosis was the independent risk factor affecting the progression of IgAN to ESRD(HR=6.437,95%CI 2.013-20.585,P=0.002).Renal histopathology showed that the deposition of complement C3c on the wall of intrarenal arterioles in the renal arteriolar lesions group(n=98)was stronger than that in non-renal arteriolar lesions group(n=18,P<0.05).IgAN patients with renal arteriolosclerosis present with serious clinical and pathological manifestations,and renal prognosis.Abnormal activation of complement system may be involved in the pathogenesis of intrarenal arteriolosclerosis.

关 键 词：肾小球肾炎 IGA 小动脉硬化 预后 临床病理特点 补体C3c 

分 类 号：R692.31[医药卫生—泌尿科学]