CAJ | 학술논문

目的：探讨IgA肾病患者的临床表现与病理特征之间的相关性。方法对陕西省中医院肾病科2008年1月至2012年12月间确诊为原发性 IgA肾病的300例患者的临床病理资料进行研究分析。结果①中青年组发病比例最高(90%)；各年龄段均以血尿、蛋白尿为主要临床表现。高血压、肾功异常在≥60岁组发生率最高,分别为29.3%和28%。②免疫荧光IgA+IgM病理类型所占比例最高(36%),其次为单纯性IgA(29.7%)、IgA+IgM+IgG(17.7%)、IgA+IgG(16.7%)。Ⅰ~Ⅲ级分型中免疫荧光单纯 IgA所占比例最高；在 IV 和Ⅴ级中以 IgA+IgM沉积所占比例最高,分别为45.5%、81.8%。所有 IgA 肾病中表现为 C3沉积的比例较高,为63.3%。③肾组织病理改变分级以Lee分级Ⅰ~Ⅳ为主,占96.3%。Ⅰ~Ⅴ级病理改变的临床表现均以血尿、蛋白尿为主,相比其他临床表现更多见(P<0.05),各病理分级中血尿、蛋白尿、血尿合并蛋白尿、高血压发生率无显著性差异,而肾功能异常的比例以Ⅴ级为著,其差异具有统计学意义(P<0.05)。④Ⅰ~Ⅴ级病理改变中尿 RBC、尿蛋白异常所占比例无显著差异；病理类型Ⅳ级血清中C3下降最显著(P<0.05)；病理类型Ⅴ级病例血清中 IgA 升高的比例最低,其差异具有统计学意义(P<0.05)。而血清中肌酐异常的比例随着病理类型分级的升高,呈逐渐上升趋势,以病理类型Ⅴ级血清肌酐异常的比例最高。结论 IgA肾病具有临床表现、病理改变多样化等特点,IgA 肾病血尿、蛋白尿和高血压的发生率与病理分级无相关性,但随着病理分级的升高,肾功能异常的发生率增高。
목적：탐토IgA신병환자적림상표현여병리특정지간적상관성。방법대합서성중의원신병과2008년1월지2012년12월간학진위원발성 IgA신병적300례환자적림상병리자료진행연구분석。결과①중청년조발병비례최고(90%)；각년령단균이혈뇨、단백뇨위주요림상표현。고혈압、신공이상재≥60세조발생솔최고,분별위29.3%화28%。②면역형광IgA+IgM병리류형소점비례최고(36%),기차위단순성IgA(29.7%)、IgA+IgM+IgG(17.7%)、IgA+IgG(16.7%)。Ⅰ~Ⅲ급분형중면역형광단순 IgA소점비례최고；재 IV 화Ⅴ급중이 IgA+IgM침적소점비례최고,분별위45.5%、81.8%。소유 IgA 신병중표현위 C3침적적비례교고,위63.3%。③신조직병리개변분급이Lee분급Ⅰ~Ⅳ위주,점96.3%。Ⅰ~Ⅴ급병리개변적림상표현균이혈뇨、단백뇨위주,상비기타림상표현경다견(P<0.05),각병리분급중혈뇨、단백뇨、혈뇨합병단백뇨、고혈압발생솔무현저성차이,이신공능이상적비례이Ⅴ급위저,기차이구유통계학의의(P<0.05)。④Ⅰ~Ⅴ급병리개변중뇨 RBC、뇨단백이상소점비례무현저차이；병리류형Ⅳ급혈청중C3하강최현저(P<0.05)；병리류형Ⅴ급병례혈청중 IgA 승고적비례최저,기차이구유통계학의의(P<0.05)。이혈청중기항이상적비례수착병리류형분급적승고,정축점상승추세,이병리류형Ⅴ급혈청기항이상적비례최고。결론 IgA신병구유림상표현、병리개변다양화등특점,IgA 신병혈뇨、단백뇨화고혈압적발생솔여병리분급무상관성,단수착병리분급적승고,신공능이상적발생솔증고。
ABSTRACT:Objective To explore the relationship between clinical manifestations and pathological changes in patients with IgA nephrophathy.Methods To compare the clinical pathological data of 300 patients with primary IgA nephrophathy,who were diagnosised in the Shaanxi Chinese Hospital from Jan.2008 to Dec.2012.Results① The young and middle-aged had the highest incidence of IgA nephrophathy, about 9 0%, hematuria and proteinuria was the primary clinical manifestations among all ages,the incidence of hypertension and abnormal renal function was higher among 60-year age,about 29.3% and 28%.② The IgA+IgM deposition measured by immunofluorescence was the most common pathological type(3 6%).The ratio of IgA deposition was higher in LeeⅠ-Ⅲ of IgA nephrophathy,while IgA+IgM deposition was more common in Lee Ⅳ and Ⅴ (45.5% and 81.8%). The deposition of C3 was common in all IgA nephrophathy(6 3 .3%).③ Lee Ⅰ-Ⅳ grades were the more common grades,covered over 96.3%.Hematuria and proteinuria were the primary clinical manifestations inⅠ-Ⅴpathological changes grading.The incidence of hematuria,proteinuria,hematuria with proteinuria,and hypertension had no significant difference in all pathologic grading,but abnormal renal function had significant difference in Lee Ⅴ(P<0 .0 5 ).④ Abnormal of urine protein and RBC did not have significant difference in Lee Ⅰ-Ⅴ;C3 depositions in serum had significant difference in Ⅳ pathologic grading(P<0 .0 5 ).The elevation of IgA in serum had significant difference in Lee Ⅴ(P<0 .0 5 ).The proportion of abnormal serum creatinine(SCr)increased with the pathological grades,showing a rising trend.Conclusion IgA nephropathy has the characteristics of diversification of clinical manifestations and pathology changes. The incidences of hematuria, proteinuria and hypertension in IgA nephrophathy patients have no correlation with pathological grading;but with pathological grade promotion,the incidence of abnormal renal function increases.