肾血管病变在IgA肾病中的临床意义

Clinical Significance of Renal Angiopathy in IgA Nephropathy

摘要: 目的：探讨肾血管病变在IgA肾病中的临床意义及肾血管病变的风险因素。方法：收集2017年1月至2017年8月在我院IgA确诊肾病患者的临床病理资料，根据是否发生肾血管病变将其分为肾血管病变组(renal vascular lesions group, RVL组)和非肾血管病变组(non renal vascular lesions group, NRVL组)。观察RVL和NRVL组患者的临床病理资料差异。采用多因素Logsitick分析观察影响肾血管病变的风险因素。结果：共纳入105例患者，其中RVL组59例，NRVL组47例，RVL组年龄、病程、收缩压、血肌酐、24小时尿蛋白定量、血尿酸高于NRVL组(均P < 0.05)。RVL组的血白蛋白水平、eGFR低于NRVL组。RVL组病理分级高于NRVL组(P < 0.05)，RVL组炎性细胞浸润、间质纤维化、肾小管萎缩、新月体病变、肾小球硬化性病变、毛细血管襻IgA沉积和C3沉积发生率均显著高于RNVL组(P < 0.05)；RVL组IgG沉积、IgM沉积发生率均低于NRVL组(P < 0.05)。多因素Logsitick分析结果显示，收缩压 > 140 mmHg、血尿酸异常、肾间质纤维化、24 h尿蛋白定量、eGFR ≤ 120 ml∙min−1∙(1.73 m2)−1是影响肾血管病变的风险因素(P < 0.05)。结论：1) IgA肾病患者具有较高的肾间质血管病变发生率，肾间质血管病变是IgA肾病的重要病理特征。2) 肾间质血管病变的IgA肾病患者临床指标和病理损害更为严重，肾间质血管病变在一定程度上有助于判定IgA肾病的严重程度和预后。3) 收缩压 > 140 mmHg、血尿酸异常、肾间质纤维化、24 h尿蛋白定量、eGFR ≤ 120 ml∙min−1∙(1.73 m2)−1是影响肾血管病变的风险因素。

Abstract: Objective: To explore the clinical significance and risk factors of renal angiopathy in IgA nephropa-thy. Methods: Clinicopathological data of patients diagnosed with IgA nephropathy in our hospital from January 2017 to August 2017 were collected, according to whether renal vascular lesions oc-curred. It is divided into renal vascular lesions group, and non renal vascular lesions group, com-paring clinical andpathological features and prognosis between the two groups. The risk factors of renal vascular disease were analyzed by multi factor logsitick analysis. Results: A total of 105 pa-tients were included. There were 59 patients in the RVL group and 47 patients in the NRVL group. Age, course of disease, systolic blood pressure, serum creatinine, 24-hour urine protein level and blood uric acid in the RVL group were higher than those in the NRVL group (P < 0.05). The serum albumin level and estimated glomerular filtration rate in RVL group were lower than those in NRVL group. The pathological grade of RVL group was higher than that of NRVL group (P < 0.05), and the incidence of inflammatory cell infiltration, interstitial fibrosis, renal tubule atrophy, crescent body lesion, glomerulosclerosis, IgA deposition and C3 deposition in RVL group was significantly higher than that in RNVL group (P < 0.05). The incidence of IgG deposition and IgM deposition in RVL group was lower than that in NRVL group (P < 0.05). Multivariate logsitick analysis showed that systolic blood pressure > 140 mmHg, abnormal blood uric acid, renal interstitial fibrosis, 24 h urine protein quantification, eGFR ≤ 120 ml∙min−1∙(1.73 m2)−1 were the risk factors for renal vascular disease (P < 0.05). Conclusion: 1) IgA nephropathy patients have a high incidence of renal interstitial vascular disease, which is an important pathological feature of IgA nephropathy. 2) The clinical and patho-logical damage of IgA nephropathy patients with renal interstitial angiopathy is more serious. Renal interstitial angiopathy is helpful to determine the severity and prognosis of IgA nephropathy to a certain extent. 3) Systolic blood pressure > 140 mmHg, blood uric acid abnormality, renal intersti-tial fibrosis, 24-hour urine protein quantification, eGFR ≤ 120 ml•min−1∙(1.73 m2)−1 are the risk fac-tors of renal vascular disease.