中国基层医药
中國基層醫藥
중국기층의약
Chinese Journal of Primary Medicine and Pharmacy
2015年
19期
2983-2986
,共4页
肾病综合征%IgA 肾病%病理学,临床%因素分析,统计学
腎病綜閤徵%IgA 腎病%病理學,臨床%因素分析,統計學
신병종합정%IgA 신병%병이학,림상%인소분석,통계학
Nephrotic syndrome%IgA nephropathy%Pathology,clinical%Factor analysis,statistics
目的：探讨IgA肾病肾病综合征患者临床病理特点及肾脏病理损害的危险因素。方法选择121例 IgA 肾病肾病综合征患者为研究对象，患者均经肾活检确诊，分析临床病理特点，根据患者肾脏的病变不同分为两组，其中病理改变较轻的 Lee 氏分级Ⅰ级、Ⅱ级患者为 Lee 氏Ⅰ～Ⅱ级组，共36例；病理改变较重的 Lee 氏分级Ⅲ级、Ⅳ级及Ⅴ级的患者为 Lee 氏Ⅲ～Ⅴ级组，共85例，比较两组患者的临床特点及临床检验指标，并且多因素分析肾脏病理损害的危险因素。结果Lee 氏Ⅲ～Ⅴ级组患者的平均病程（7．37±0．15）个月，明显长于 Lee 氏Ⅰ～Ⅱ级组的（8．82±0．24）个月，两组差异有统计学意义（t ＝12．74，P ＜0．05）；Lee 氏Ⅲ～Ⅴ级组患者的平均动脉压（105．01±16．82）mmHg，明显高于 Lee 氏Ⅰ～Ⅱ级组的（91．27±12．39）mmHg，两组差异有统计学意义（t ＝5．31，P ＜0．05）；Lee 氏Ⅲ～Ⅴ级组中高血压、尿红细胞满视野及肾功能衰竭患者明显较 Lee 氏Ⅰ～Ⅱ级组多，两组差异均有统计学意义（χ2＝14．29、9．74、8．26，均 P ＜0．05）；Lee 氏Ⅲ～Ⅴ级组患者总胆固醇与24 h 尿蛋白定量均显著低于 Lee 氏Ⅰ～Ⅱ级组，差异均有统计学意义（t1＝8．75、t2＝6．73，均P ＜0．05）；Lee 氏Ⅲ～Ⅴ级组患者血清白蛋白与血红蛋白水平均显著高于 Lee 氏Ⅰ～Ⅱ级组，差异均有统计学意义（t3＝7．42、t4＝9．156，P ＜0．05）；经 Logistic 多因素回归分析得出：在 IgA 肾病肾病综合征中，血红蛋白为保护性因素，而平均动脉压、24 h 尿蛋白定量及镜下尿红细胞＞5．0×107／L 均为危险加重因素。结论血红蛋白为 IgA 肾病肾病综合征保护性因素，而平均动脉压、24 h 尿蛋白定量及镜下尿红细胞均为其危险加重因素，由此可以对患者病情做出更准确的判断。
目的：探討IgA腎病腎病綜閤徵患者臨床病理特點及腎髒病理損害的危險因素。方法選擇121例 IgA 腎病腎病綜閤徵患者為研究對象，患者均經腎活檢確診，分析臨床病理特點，根據患者腎髒的病變不同分為兩組，其中病理改變較輕的 Lee 氏分級Ⅰ級、Ⅱ級患者為 Lee 氏Ⅰ～Ⅱ級組，共36例；病理改變較重的 Lee 氏分級Ⅲ級、Ⅳ級及Ⅴ級的患者為 Lee 氏Ⅲ～Ⅴ級組，共85例，比較兩組患者的臨床特點及臨床檢驗指標，併且多因素分析腎髒病理損害的危險因素。結果Lee 氏Ⅲ～Ⅴ級組患者的平均病程（7．37±0．15）箇月，明顯長于 Lee 氏Ⅰ～Ⅱ級組的（8．82±0．24）箇月，兩組差異有統計學意義（t ＝12．74，P ＜0．05）；Lee 氏Ⅲ～Ⅴ級組患者的平均動脈壓（105．01±16．82）mmHg，明顯高于 Lee 氏Ⅰ～Ⅱ級組的（91．27±12．39）mmHg，兩組差異有統計學意義（t ＝5．31，P ＜0．05）；Lee 氏Ⅲ～Ⅴ級組中高血壓、尿紅細胞滿視野及腎功能衰竭患者明顯較 Lee 氏Ⅰ～Ⅱ級組多，兩組差異均有統計學意義（χ2＝14．29、9．74、8．26，均 P ＜0．05）；Lee 氏Ⅲ～Ⅴ級組患者總膽固醇與24 h 尿蛋白定量均顯著低于 Lee 氏Ⅰ～Ⅱ級組，差異均有統計學意義（t1＝8．75、t2＝6．73，均P ＜0．05）；Lee 氏Ⅲ～Ⅴ級組患者血清白蛋白與血紅蛋白水平均顯著高于 Lee 氏Ⅰ～Ⅱ級組，差異均有統計學意義（t3＝7．42、t4＝9．156，P ＜0．05）；經 Logistic 多因素迴歸分析得齣：在 IgA 腎病腎病綜閤徵中，血紅蛋白為保護性因素，而平均動脈壓、24 h 尿蛋白定量及鏡下尿紅細胞＞5．0×107／L 均為危險加重因素。結論血紅蛋白為 IgA 腎病腎病綜閤徵保護性因素，而平均動脈壓、24 h 尿蛋白定量及鏡下尿紅細胞均為其危險加重因素，由此可以對患者病情做齣更準確的判斷。
목적：탐토IgA신병신병종합정환자림상병리특점급신장병리손해적위험인소。방법선택121례 IgA 신병신병종합정환자위연구대상，환자균경신활검학진，분석림상병리특점，근거환자신장적병변불동분위량조，기중병리개변교경적 Lee 씨분급Ⅰ급、Ⅱ급환자위 Lee 씨Ⅰ～Ⅱ급조，공36례；병리개변교중적 Lee 씨분급Ⅲ급、Ⅳ급급Ⅴ급적환자위 Lee 씨Ⅲ～Ⅴ급조，공85례，비교량조환자적림상특점급림상검험지표，병차다인소분석신장병리손해적위험인소。결과Lee 씨Ⅲ～Ⅴ급조환자적평균병정（7．37±0．15）개월，명현장우 Lee 씨Ⅰ～Ⅱ급조적（8．82±0．24）개월，량조차이유통계학의의（t ＝12．74，P ＜0．05）；Lee 씨Ⅲ～Ⅴ급조환자적평균동맥압（105．01±16．82）mmHg，명현고우 Lee 씨Ⅰ～Ⅱ급조적（91．27±12．39）mmHg，량조차이유통계학의의（t ＝5．31，P ＜0．05）；Lee 씨Ⅲ～Ⅴ급조중고혈압、뇨홍세포만시야급신공능쇠갈환자명현교 Lee 씨Ⅰ～Ⅱ급조다，량조차이균유통계학의의（χ2＝14．29、9．74、8．26，균 P ＜0．05）；Lee 씨Ⅲ～Ⅴ급조환자총담고순여24 h 뇨단백정량균현저저우 Lee 씨Ⅰ～Ⅱ급조，차이균유통계학의의（t1＝8．75、t2＝6．73，균P ＜0．05）；Lee 씨Ⅲ～Ⅴ급조환자혈청백단백여혈홍단백수평균현저고우 Lee 씨Ⅰ～Ⅱ급조，차이균유통계학의의（t3＝7．42、t4＝9．156，P ＜0．05）；경 Logistic 다인소회귀분석득출：재 IgA 신병신병종합정중，혈홍단백위보호성인소，이평균동맥압、24 h 뇨단백정량급경하뇨홍세포＞5．0×107／L 균위위험가중인소。결론혈홍단백위 IgA 신병신병종합정보호성인소，이평균동맥압、24 h 뇨단백정량급경하뇨홍세포균위기위험가중인소，유차가이대환자병정주출경준학적판단。
Objective To investigate the clinical pathological features of IgA nephropathy with nephrotic syndrome and risk factors for impairment of renal pathology.Methods 121 cases of IgA nephropathy with nephrotic syndrome were selected,all patients had been diagnosed with biopsy.The clinical pathological features wer analyzed, they were divided into two groups according to different kidney disease.The minor pathological changes which Leeˊs classification grade Ⅰ and grade Ⅱ patients belong to group A,with a total of 36 cases,while Leeˊs pathology heavier grade for grade Ⅲ,Ⅳ and Ⅴ grade level in patients belonging to group B,with a total of 85 cases.Clinical character-istics and clinical laboratory indicators of two groups were compared,and risk factors for renal pathological damage were analyzed in multivariate analysis.Results The average duration of group B was significantly longer than the average duration of group A,the difference was statistically significant (t =12.74,P <0.05).Mean arterial pressure of group B was significantly high than that of group A,the difference was statistically significant (t =5.31,P <0.05).Patients with hypertension,urinary erythrocytes with full vision and renal failureof group B were significantly more than those in group A,the differences were statistically significant (χ2 =14.29,9.74,8.26,all P <0.05).Total cholesterol and 24 h urinary protein excretion of group B were significantly lower than those in group A,the differences were statistically significant (t1 =8.75,t2 =6.73,all P <0.05).Serum albumin and hemoglobin levels of group B were significantly higher in group A,the differences were statistically significant (t3 =7.42,t4 =9.15,all P <0.05). Multivariate Logistic regression analysis showed,in IgA nephropathy with nephrotic syndrome,hemoglobin was a protective factor,the mean arterial pressure,24h urinary protein of red blood cells and microscopic urine >5.0 ×107 /Lwere dangerous aggravating factors.Conclusion Hemoglobin protective factors for IgA nephropathy with nephrotic syndrome,the mean arterial pressure,24h urinary protein excretion and urine red blood cells are their risk aggravating factors,they can make a more accurate judgment of the patientˊs condition.
