CAJ | 학술논문

目的探讨IgA肾病(IgAN)病史中伴发肉眼血尿患者的临床及病理特征.方法回顾性分析2006年1月至2011年12月于中山大学附属第一医院经肾活检确诊的IgAN患者,比较肾活检前伴或不伴肉眼血尿发作(肉眼血尿组和对照组)的两组患者临床及病理特征,并将肉眼血尿组按肉眼血尿发作距离肾活检时间分为3组,分析比较以探讨近期肉眼血尿发作患者伴随的临床及肾脏病理特征.结果研究纳入的1512例IgAN患者中,病史伴发肉眼血尿的比例为22.1％.肉眼血尿组血肌酐水平、24 h尿蛋白排泄量及高血压发生率均低于对照组(均P＜ 0.001),镜下血尿程度更重(P＜0.001),两组间病程差异无统计学意义(P=0.627).病理方面,肉眼血尿组的慢性指标,如球性/节段硬化、肾小管萎缩/间质纤维化程度等均低于对照组(均P＜ 0.001),但活动性指标,如新月体比例(P=0.024)、袢坏死比例(P=0.001)及系膜增生程度(P=0.026)均高于对照组.肉眼血尿发作1个月内行肾穿刺活检的患者伴更大量蛋白尿(P=0.010)及镜下血尿(P＜0.001),病理上内皮细胞增生、袢坏死及新月体形成的比例均更高(均P＜ 0.05).结论病史中伴有肉眼血尿的IgAN患者临床及病理慢性改变较轻,病理活动性病变更明显,特别是在1个月内发生肉眼血尿患者中更为突出.
목적 탐토IgA신병(IgAN)병사중반발육안혈뇨환자적림상급병리특정.방법 회고성분석2006년1월지2011년12월우중산대학부속제일의원경신활검학진적IgAN환자,비교신활검전반혹불반육안혈뇨발작(육안혈뇨조화대조조)적량조환자림상급병리특정,병장육안혈뇨조안육안혈뇨발작거리신활검시간분위3조,분석비교이탐토근기육안혈뇨발작환자반수적림상급신장병리특정.결과 연구납입적1512례IgAN환자중,병사반발육안혈뇨적비례위22.1％.육안혈뇨조혈기항수평、24 h뇨단백배설량급고혈압발생솔균저우대조조(균P＜ 0.001),경하혈뇨정도경중(P＜0.001),량조간병정차이무통계학의의(P=0.627).병리방면,육안혈뇨조적만성지표,여구성/절단경화、신소관위축/간질섬유화정도등균저우대조조(균P＜ 0.001),단활동성지표,여신월체비례(P=0.024)、번배사비례(P=0.001)급계막증생정도(P=0.026)균고우대조조.육안혈뇨발작1개월내행신천자활검적환자반경대량단백뇨(P=0.010)급경하혈뇨(P＜0.001),병리상내피세포증생、번배사급신월체형성적비례균경고(균P＜ 0.05).결론 병사중반유육안혈뇨적IgAN환자림상급병리만성개변교경,병리활동성병변경명현,특별시재1개월내발생육안혈뇨환자중경위돌출.
Objective To investigate the clinical and pathological characteristics of IgA nephropathy (IgAN) with macrohematuria (MH).Method 1512 consecutive patients with biopsyproven IgAN diagnosed from January 2006 to December 2011 were enrolled,and divided into MH group and control group respectively,according to whether there existed episodes of MH before renal biopsy.The clinical and pathological characteristics were compared between two groups.Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH.Results The rate of MH in history was 22.1％.MH group patients had significantly lower serum creatinine,slighter proteinuria,lower prevalence of hypertension and heavier microhematuria than control group (all P ＜ 0.001).The prebiopsy durations were similar in two groups (P=0.627).In MH group,chronic pathological indicators,including global/segmental sclerosis,tubule atrophy/interstitial fibrosis were all slighter (all P＜ 0.001),whereas activity indicators,including necrosis lesions,crescents and mesangial proliferation were all more severe compared with control group (all P ＜ 0.05).Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria,higher prevalence of necrosis lesions,more severe crescents formation,and endothelial proliferation (all P ＜ 0.05).Conclusions IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations,however more active pathological changes especially in those who suffer episode of MH recently.