186例成人IgA肾病临床病理分析

A Clinicopathological Study of 186 Adult Cases with IgA Nephropathy Diagnosed by Renal Biopsy

目的 研究成人IgA肾病 (IgAN)的临床、病理特点及相关性。 方法 将我科于 1996年 8月～ 2 0 0 3年 12月收治的原发性成人IgAN186例按照年龄分成 2组 ,根据各年龄组的临床及其组织学特点进行临床与病理分型的分析。 结果 186例成人IgAN临床表现以无症状性尿检异常最常见 ,占 12 2例 ( 65 .6% ) ,其次是慢性肾炎和肾病综合征 ,分别占 2 8例 ( 15 .1% )和 2 5例 ( 13 .4% )。老年组肾病综合征和急性肾功能衰竭的发生率高于青壮年组。病理类型以局灶节段硬化性肾小球肾炎最常见 ,占 67例 ( 3 6% ) ,其次是系膜增生性肾小球肾炎、轻微病变肾小球肾炎 ,分别为 47例( 2 5 .3 % )和 3 5例 ( 18.8% )。 结论 成人IgAN的临床病理表现多样化并且有一定特点。临床表现以无症状性尿检异常最常见 ,病理类型以局灶节段性肾小球病变最常见。

Objective To investigate the clinical features,histopathology and clinicopathological correlation in 186 adult cases with IgA nephropathy(IgAN) retrospectively. Methods 186 adult cases of IgA nephropathy were divided into two groups according to their age,and the clinical and renal pathological features were analyzed. Results Asymptomatic hematuria with or without the presence of proteinuria was the most common clinical manifestation(65.6%),followed by chronic nephritis(15.1%) and nephritic syndrome(13.4%) Higher incidence of nephrotic syndrome and acute renal failure was found in elder group(50-68years). Pathologically,focal segmental glomerulosclerosis(FSGS)was the most frequent type(36%),followed by mesangial proliferative glomerulosclerosis(MsPGN,25.3%)and minimal lesion(ML,18.8%) among the 186 adult patients with IgAN. Conclusions The relation between the clinical manifestation and pathomorphological type of IgAN is complicated. Asymptomatic hematuria with or without the presence of proteinuria is the most common clinical manifestation and focal segmental glomerular lesion is the most common pathomorphological type of IgAN.