IgA肾病伴弥漫性薄肾小球基底膜的临床和病理特点

TheclinicalandpathologicalcharactersofIgAnephropathywithdiffusethinglomerularbasementmembrane

通过测量肾小球基底膜厚度来了解ＩｇＡ肾病特点。对８３例原发性ＩｇＡ肾病依据肾小球基底膜（ＧＢＭ）厚度分为弥漫性薄ＧＢＭ组（ＴＧＢＭ组）和非ＴＧＢＭ组。ＴＧＢＭ与非ＴＧＢＭ组ＧＢＭ厚度分别为２３５±２９ｎｍ、３８４±３２ｎｍ，两组差异有高度显著性（Ｐ＜０．０１）。ＴＧＢＭ组１２例患者血肌酐均正常（＜１３３μｍｏｌ／Ｌ），两组差异有显著性（Ｐ＜０．０５）。ＴＧＢＭ与非ＴＧＢＭ组尿蛋白≥３．０ｇ／２４小时者分别为８．４％（１／１２例）和３２．４％（２３／７１例），前者较后者发生率低，但无显著性差异（Ｐ＞０．１）。ＴＧＢＭ与非ＴＧＢＭ组高血压发生率分别为８．４％（１／１２例）、２９．６％（１２／７１例），虽前者较后者有减少，但无显著性差异（Ｐ＞０．１）。轻度系膜增生性肾炎在ＴＧＢＭ和非ＴＧＢＭ组分别占８３．３％（１０／１２例）和４９．３％（３５／７１例）（Ｐ＜０．０５）。上述结果显示原发性ＩｇＡ肾病伴弥漫性薄肾小球基底膜患者临床表现与病理改变较轻，属原发性ＩｇＡ肾病中较良性的一组病人。

ToinvestigatethecharactersofIgAnephropathybydetectingthethicknessofglomerularbasementmembrane(GBM),83patientswithprimaryIgAnephropathyweredividedintotwogroups,difusethinGBM(TGBM)groupandnon-difusethinGBM(non-TGBM)groupaccordingtoGBMthicknes.ThethicknesofTGBMgroupandnon-TGBMgroupwas235±29nmand384±32nmrespectively(P<0.01).AlpatientsofTGBMgrouphadnormalrenalfunction(Scr≤133μmol/L),but32.4%(23/71cases)patientsofnon-TGBMgrouphadabnormalrenalfunction(Scr>133μmol/L)(P<0.05).Theincidenceofheavyproteinuria(≥3.0g/24小时)inTGBMandnon-TGBMgroupwere8.4%(1/12cases)and32.4%(23/71cases)respectively,buttherewasnosignificantdiferencebetwentwogroups(P>0.1).TheincidenceofhypertensionofTGBMgroup(1/12cases,8.4%)waslowerthanthatinnon-TGBMgroup(21/71cases,29.6%),buttherewasnosignificantdif-ferencebetweentwogroups(P>0.1).ThepathologicaltypesofTGBMgroupwasmainlymildmesangialprolif-erativeglomerulonephritis(MsPGN),therateofcomparativelyseverepathologicalchangesinTGBMgroupwaslowerthanthatinnon-TGBMgroup.ThisresultsuggestedIgAnephropathywithTGBMbelongedtobenigntypeofIgAnephropathy.