中老年IgA肾病的临床病理特征和转归

Clinicopathological characteristics and outcomes of IgA nephropathy in older adu lts

目的 探讨中老年IgA肾病临床和病理特性及其与预后的关系。方法 分析 65例 45岁以上IgA肾病临床和病理特征 ,并与 659例年轻患者 (≤ 45岁 )比较。分析肾存活率并与年轻组比较。结果 中老年组血胆固醇、甘油三酯以及高血压或肾功能不全发生率显著高于年轻组 (P<0 0 5)。≥ 60岁亚组收缩压和尿蛋白显著高于 45～ 59岁亚组 (P <0 0 5 )。两组Lee氏病理分级分布无显著性差别 (P >0 0 5)。中老年组肾小管 间质指数和血管指数显著高于年轻组 (P <0 0 5) ,但肾小球指数和新月体指数无显著性差异 (P >0 0 5)。两组 5年肾存活率均为 85 6 % ,无显著性差别(P >0 0 5)。结论 中老年IgA肾病高血压、高脂血症和肾功能不全发生率较高 ,肾血管和肾间质损害比较突出 ,故应注意积极控制血压和高脂血症。

Objective To study the clinical and path ol ogical characteristics and its relation with prognosis of IgA nephropathy in eld erly. Methods Clinical and pathological characteristics of IgA nephropathy in 65 patients over age 45 were analyzed and compared to 659 patients under 45 years old. Kaplan-Meier survival analysis was performed to c ompare renal survival rate of older and younger groups. Results Hypercholesterolemia, hyperlipidemia and the prevalence of hypertension or renal function insufficiency were more common in the older group than those in younger group (P<0.05). Patients over 60 years old had higher systolic pressu re and 24h-urinary protein excretion rate than a subgroup of patients between 4 5~60 years old (P<0.05). There was no significant difference in the distribu tion of Lee's pathological grading (P>0.05). The renal tubulose-interstitia l index and vascular index were significantly higher in older group than those o f younger group (P<0.05), while there were no significant difference in glom erular index and crescentic index between the two groups (P>0.05). The 5-ye ar renal survivals were 85.6% in both groups, without significant difference ( P>0.05). Conclusions Hypertension, hyperlipidemia, re nal function insufficiency, vascular and tubulose-interstitial lesions are more common in IgA nephropathy patients over age 45. Therefore, it is important to c ontrol hypertension and hyperlipidemia in older patients.