中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2010年
10期
742-747
,共6页
萨茹拉%刘红%於佳炜%章晓燕%蒋素华%邹建洲%滕杰%吉俊%钟一红%傅辰生%陈利明%袁敏%丁小强
薩茹拉%劉紅%於佳煒%章曉燕%蔣素華%鄒建洲%滕傑%吉俊%鐘一紅%傅辰生%陳利明%袁敏%丁小彊
살여랍%류홍%어가위%장효연%장소화%추건주%등걸%길준%종일홍%부신생%진리명%원민%정소강
肾小球肾炎,IgA%蛋白尿%血尿%活组织检查%高血压
腎小毬腎炎,IgA%蛋白尿%血尿%活組織檢查%高血壓
신소구신염,IgA%단백뇨%혈뇨%활조직검사%고혈압
Glomerulonephritis,IgA%Proteinuria%Hematuria%Biopsy%Hypertension
目的 了解表现为少量蛋白尿和(或)血尿IgA肾病(IgAN)患者的肾脏病理特征及其与临床表现的关系.方法 对1993年1月至2009年10月肾活检确诊为IgAN,且表现为少量蛋白尿(＜1 g/24 h)和(或)血尿,Scr＜133 μmol/L的患者的临床和病理资料进行回顾性分析.病理学分级参照Lee分级及Katafuchi半定量积分标准.应用多因素logistic回归法分析肾脏病理损伤的危险因素.结果 符合入选标准共316例,男123例,女193例,肾穿时年龄(33.10±10.69)岁.蛋白尿伴血尿占84.5%、单纯血尿占7.6%、单纯蛋白尿占7.9%.16.5%患者伴有高血压.CKD1、2、3期分别占76.9%、20.9%和2.2%.LeeⅢ级及以上患者占31.3%.52.8%患者有不同程度肾小球硬化;20.3%伴新月体形成;22.5%伴小管萎缩;16.8%有间质纤维化;24.7%有血管病变.肾小球硬化积分与估算肾小球滤过率(eGFR)呈负相关;与蛋白尿及平均动脉压(MAP)呈正相关.肾小管间质病变积分与eGFR及血红蛋白(Hb)呈负相关;与尿蛋白量呈正相关.血管病变积分与MAP呈正相关;与eGFR呈负相关(均P＜0.05).多因素logistic回归分析结果显示,肾活检时尿蛋白量(OR=8.564,P＜0.01)、Scr(OR=1.031,P＜0.01)及Hb(OR=0.975,P＜0.01)是肾脏病理损伤(LeeⅢ级以上)的独立危险因素.结论 部分表现为少量蛋白尿和(或)血尿IgAN患者的病理改变并不轻,且肾功能已减退.尿蛋白量、Scr、Hb是预测肾脏病理损伤程度的独立危险因素.肾活检对这些患者明确诊断、判断病情和预后、制定个体化治疗方案十分重要.
目的 瞭解錶現為少量蛋白尿和(或)血尿IgA腎病(IgAN)患者的腎髒病理特徵及其與臨床錶現的關繫.方法 對1993年1月至2009年10月腎活檢確診為IgAN,且錶現為少量蛋白尿(＜1 g/24 h)和(或)血尿,Scr＜133 μmol/L的患者的臨床和病理資料進行迴顧性分析.病理學分級參照Lee分級及Katafuchi半定量積分標準.應用多因素logistic迴歸法分析腎髒病理損傷的危險因素.結果 符閤入選標準共316例,男123例,女193例,腎穿時年齡(33.10±10.69)歲.蛋白尿伴血尿佔84.5%、單純血尿佔7.6%、單純蛋白尿佔7.9%.16.5%患者伴有高血壓.CKD1、2、3期分彆佔76.9%、20.9%和2.2%.LeeⅢ級及以上患者佔31.3%.52.8%患者有不同程度腎小毬硬化;20.3%伴新月體形成;22.5%伴小管萎縮;16.8%有間質纖維化;24.7%有血管病變.腎小毬硬化積分與估算腎小毬濾過率(eGFR)呈負相關;與蛋白尿及平均動脈壓(MAP)呈正相關.腎小管間質病變積分與eGFR及血紅蛋白(Hb)呈負相關;與尿蛋白量呈正相關.血管病變積分與MAP呈正相關;與eGFR呈負相關(均P＜0.05).多因素logistic迴歸分析結果顯示,腎活檢時尿蛋白量(OR=8.564,P＜0.01)、Scr(OR=1.031,P＜0.01)及Hb(OR=0.975,P＜0.01)是腎髒病理損傷(LeeⅢ級以上)的獨立危險因素.結論 部分錶現為少量蛋白尿和(或)血尿IgAN患者的病理改變併不輕,且腎功能已減退.尿蛋白量、Scr、Hb是預測腎髒病理損傷程度的獨立危險因素.腎活檢對這些患者明確診斷、判斷病情和預後、製定箇體化治療方案十分重要.
목적 료해표현위소량단백뇨화(혹)혈뇨IgA신병(IgAN)환자적신장병리특정급기여림상표현적관계.방법 대1993년1월지2009년10월신활검학진위IgAN,차표현위소량단백뇨(＜1 g/24 h)화(혹)혈뇨,Scr＜133 μmol/L적환자적림상화병리자료진행회고성분석.병이학분급삼조Lee분급급Katafuchi반정량적분표준.응용다인소logistic회귀법분석신장병리손상적위험인소.결과 부합입선표준공316례,남123례,녀193례,신천시년령(33.10±10.69)세.단백뇨반혈뇨점84.5%、단순혈뇨점7.6%、단순단백뇨점7.9%.16.5%환자반유고혈압.CKD1、2、3기분별점76.9%、20.9%화2.2%.LeeⅢ급급이상환자점31.3%.52.8%환자유불동정도신소구경화;20.3%반신월체형성;22.5%반소관위축;16.8%유간질섬유화;24.7%유혈관병변.신소구경화적분여고산신소구려과솔(eGFR)정부상관;여단백뇨급평균동맥압(MAP)정정상관.신소관간질병변적분여eGFR급혈홍단백(Hb)정부상관;여뇨단백량정정상관.혈관병변적분여MAP정정상관;여eGFR정부상관(균P＜0.05).다인소logistic회귀분석결과현시,신활검시뇨단백량(OR=8.564,P＜0.01)、Scr(OR=1.031,P＜0.01)급Hb(OR=0.975,P＜0.01)시신장병리손상(LeeⅢ급이상)적독립위험인소.결론 부분표현위소량단백뇨화(혹)혈뇨IgAN환자적병리개변병불경,차신공능이감퇴.뇨단백량、Scr、Hb시예측신장병리손상정도적독립위험인소.신활검대저사환자명학진단、판단병정화예후、제정개체화치료방안십분중요.
Objective To clarify the relationship between clinical manifestation and pathological features of IgA nephropathy (IgAN) patients with mild proteinuria and/or hematuria.Methods Clinicopathological data from 316 biopsy-proven IgAN cases (proteinuria＜1 g/24 h and/or hematuria, and Scr＜133 μmol/L) from our hospital between January 1993 and October 2009 were studied retrospectively. The renal histopathology was quantified according to Lee's grading and Katafuchi's semi-quantitative standard, and the risk factors for renal pathological lesions were evaluated using multifactor logistic regression analysis. Results Among these 316 patients, 123 were male and 193 patients were female. The mean age at the time of renal biopsy was (33.10±10.69) years old. Clinical features were found as follows: hematuria with proteinuria was found in 267 patients (84.5%), isolated hematuria in 24 patients (7.6%), and isolated proteinuria in 25 patients (7.9%). 16.5% of patients had hypertension. The percentages of CKD stage Ⅰ, Ⅱ, Ⅲ were 76.9%, 20.9% and 2.2%, respectively. 31.3% of patients presented Lee's grade Ⅲ or more severe.52.8% of patients had various degrees of glomerulosclerosis. Crescent formation was observed in 20.3% of patients. 22.5% of patients showed tubular atrophy;16.8% showed interstitial fibrosis and 24.7% also had renal vascular lesions. The extent of glomerulosclerosis was negatively correlated with eGFR levels, but positively correlated with the amount of proteinuria and mean arterial pressure (MAP) level (P＜0.05). The score of tubulointerstitial lesion was positively correlated with the amount of proteinuria and negatively correlated with eGFR and hemoglobin (Hb)level (P＜0.05). The degree of renal vascular lesion was also correlated to MAP level positively and eGFR level negatively (P＜0.05). Multifactor logistic regression analysis revealed that proteinuria, Scr and Hb at the time of renal biopsy were independent risk factors for severe renal pathological lesions (Lee's grade Ⅲ or more severe) with odds ratio of 8.564, 1.031 and 0.975 respectively (all P＜0.01). Conclusions Severe renal histological lesions and decrease of renal function may be seen in some IgAN patients with mild proteinuria and/or hematuria. The levels of proteinuria,Scr and Hb are the independent risk factors for severe renal pathological lesions. Renal biopsy is important in these patients in order to make diagnosis and individual treatment.
