不同血型原发性IgA肾病患者的临床病理特征  

Clinical and pathological characteristics of primary IgA nephropathy patients with different blood types

作　　者：刘顺瑶 鄂静[2] 李晶[3] 李静[3] 李博[2] 马丹娜 田文竹 郑亚莉 Liu Shunyao;E Jing;Li Jing;Li Jing;Li Bo;Ma Danna;Tian Wenzhu;Zheng Yali(The Third Clinical Medical College of Ningxia Medical University,Yinchuan 750000,China;Department of Nephrology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750000,China;Department of Pathology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750000,China)

机构地区：[1]宁夏医科大学第三临床医学院,银川750000 [2]宁夏回族自治区人民医院肾脏内科,银川750000 [3]宁夏回族自治区人民医院病理科,银川750000

出　　处：《中国医师杂志》2023年第4期516-520,527,共6页Journal of Chinese Physician

基　　金：国家自然科学基金(81860136);宁夏回族自治区重点研发计划(2022BEG03121);宁夏回族自治区自然科学基金(2022AAC02059,2020AAC03334)。

摘　　要：目的探讨不同血型原发性IgA肾病(IgAN)患者的临床资料和病理改变的差异。方法收集2016年5月至2021年5月在宁夏回族自治区人民医院经肾活检确诊为原发性IgAN患者的临床病理资料,按血型分为A、O、B、AB组,分析肾活检时四组患者的临床资料及病理改变。结果共纳入原发性IgAN患者258例,包括A型87例、O型74例、B型72例、AB型25例,男女比1.34∶1,中位年龄36(29,47)岁。四组患者的年龄、性别、血压、血红蛋白、肾功能等临床资料差异无统计学意义(均P>0.05),A、B型组患者中性粒细胞相关载脂蛋白(NGAL)高于其他血型患者(均P<0.05);四组患者病理上系膜细胞增生(M)、毛细血管内细胞增生(E)、肾小球节段硬化(S)、肾小管萎缩/间质纤维化(T)、新月体(C)病变程度、硬化肾小球比例差异无统计学意义(均P>0.05)。按性别进行亚组分析,各血型组男性患者血红蛋白、血尿酸、血肌酐高于女性患者(均P<0.05),但估算肾小球滤过率(eGFR)、尿蛋白差异无统计学意义(均P>0.05),A、O型组女性镜下血尿较男性重;病理表现上A型血女性M、E、S、C病变较男性重,B型血男性S、T较女性重。四组男性、女性之间一般基线资料、炎症、肾脏指标差异无统计学意义(均P>0.05),病理上B型血男性M病变较其他血型患者重,B型血女性患者S、T病变较其他血型患者轻。结论A型血女性临床和病理表现较重,B型血女性病理表现较轻,但B型血男性病理较重。Objective To investigate the differences of clinical data and pathological changes in patients with primary IgA nephropathy(IgAN)with different blood types.Methods The clinical and pathological data of patients with primary IgAN diagnosed by renal biopsy in the People's Hospital of Ningxia Hui Autonomous Region from May 2016 to May 2021 were collected.They were divided into groups A,O,B and AB according to blood group.The clinical manifestations and pathological changes of the four groups during renal biopsy were analyzed.Results A total of 258 patients with primary IgAN were included,including 87 cases of type A,74 cases of type O,72 cases of type B and 25 cases of type AB.The male to female ratio was 1.34∶1,and the median age was 36(29,47)years old.There was no significant difference in age,sex,blood pressure,hemoglobin and renal function among the four groups(all P>0.05).Neutrophil gelatinase-associated lipocalin(NGAL)in patients with type A and B was higher than other groups(all P<0.05).There were no significant differences in mesangial cell hyperplasia(M),capillary cell hyperplasia(E),glomerular segmental sclerosis(S),renal tubule atrophy/interstitial fibrosis(T),crescent body(C)lesions and proportion of sclerosed glomeruli among the four groups(all P>0.05).Subgroup analysis by gender showed that the hemoglobin,uric acid and creatinine of male patients were higher than those of female patients(all P<0.05),but the estimated glomerular filtration rate(eGFR)and urinary protein had no statistical significance(all P>0.05).Women with blood type A and O were heavier than men under microscope.The pathological manifestations of M,E,S and C lesions in women with type A blood were heavier than those in men,and S and T lesions in men with type B blood were heavier than those in women.There was no significant difference in the general baseline data,inflammation and kidney indexes between the four groups of men and women(all P>0.05).Pathologically,the M lesions of men with B blood group were more severe than those of ot

关 键 词：肾小球肾炎 IGA ABO血型系统 性别 

分 类 号：R692.31[医药卫生—泌尿科学]