IgA肾病蛋白尿量与小管间质病理损伤关联性及糖皮质激素治疗价值分析  

Correlation between albuminuria volume and tubulointerstitial pathological damage in IgA nephropathy and therapeutic value of glucocorticoid

作　　者：乔冠华 孙晓莉[1] 胡贵林[1] QIAO Guan-hua;SUN Xiao-li;HU Gui-lin(Department of Nephrology and Rheumatology,Anyang District Hospital of Puyang,Anyang,Henan 455000,China)

机构地区：[1]濮阳市安阳地区医院肾病风湿科,河南安阳455000

出　　处：《医药论坛杂志》2025年第5期495-499,共5页Journal of Medical Forum

摘　　要：目的探讨IgA肾病蛋白尿量与小管间质病理损伤关联性及糖皮质激素治疗价值。方法选择2019年11月至2022年11月于濮阳市安阳地区医院经肾活检病理确诊为IgA肾病的患者112例,按照患者24 h尿蛋白定量2.0 g为界对所有患者进行分组,分为显著性蛋白尿组和非显著性蛋白尿组,其中显著性蛋白尿组患者44例,而非显著性蛋白尿组68例。按照肾小管间质损伤程度将其分为无(16例)、轻(37例)、中(47例)、重(12例)组。对所有患者均采用糖皮质激素治疗,治疗周期为半年。将显著性蛋白尿组和非显著性蛋白尿组患者临床指标进行对比,分析IgA肾病蛋白尿量与小管间质病理损伤之间的相关性,比较治疗前后患者各项生化指标的变化。结果显著性蛋白尿组患者24 h尿蛋白定量比非显著性蛋白尿组高(P<0.05);随着肾小管间质损伤程度的加重,24 h尿蛋白定量逐渐升高,IgA肾病蛋白尿量与小管间质病理损伤程度呈正相关关系(P<0.05);治疗后显著性蛋白尿组患者和非显著性蛋白尿组患者24尿蛋白定量、血肌酐、尿素氮、血钙均比治疗前低,而肾小球滤过率(estimated glomerular filtration rate,eGFR)比治疗前高(均P<0.05),而治疗前后患者血尿酸、白蛋白等指标比较,差异无统计学意义(P>0.05)。结论IgA肾病蛋白尿量与小管间质病理损伤存在一定的关联性,患者24 h尿蛋白定量与肾小管间质损伤程度呈正相关关系,而采用糖皮质激素应用于IgA肾病患者的治疗中,可减少蛋白尿,有助于患者肾功能的改善,同时对钙磷水平予以调节,预后较好。Objective To investigate the correlation between proteinuria and tubulointerstitial pathological damage in IgA ne-phropathy and the value of glucocorticoid therapy.Methods A total of 112 patients with IgA nephropathy confirmed by renal biopsy pathology in the Anyang District Hospital of Puyang from November 2019 to November 2022 were selected.All patients were divided into a significant proteinuria group and a non-significant proteinuria group,with 44 patients in the significant proteinuria group and 68 patients in the non-significant proteinuria group,based on a 24-hour urine protein quantification of 2.0 g.According to the degree of renal tubulointerstitial injury,they were divided into none(16 cases),mild(37 cases),moderate(47 cases),and severe(12 cases)groups.All patients were treated with glucocorticoids,with a treatment cycle of six months.Compare the clinical indicators of patients with significant proteinuria and non-significant proteinuria,analyze the correlation between IgA nephropathy proteinuria and tubulointerstitial pathological damage,and compare the changes in various biochemical indicators of patients before and after treatment.Results Patients in the significant proteinuria group had a higher 24-hour urine protein quantification than that in non-significant proteinuria group(P<0.05).With the severity of tubulointerstitial injury,24 h urinary protein quantity gradually increased,and there was a positive correlation between albu-minuria volume and tubulointerstitial injury degree in IgA nephropathy(P<0.05).After treatment,24 urinary protein,serum creatinine,urea nitrogen and serum calcium in patients with significant proteinuria group and non-significant proteinuria group were all lower than those before treatment,while estimated glomerular filtration rate(eGFR)was higher than that before treatment(all P<0.05),while there was no statistical significance in blood uric acid and albumin before and after treatment(P>0.05).Conclusion There is a certain correlation between proteinuria and tubulointersti

关 键 词：IGA肾病 蛋白尿量 小管间质 病理损伤 关联性 糖皮质激素 治疗价值 

分 类 号：R692.3[医药卫生—泌尿科学]