IgA肾病肾小管间质病变与临床及病理的关系

Renal Tubulointerstitial Damage is Correlated with Clinical and Pathological Changes in Patients With IgA Nephropathy

目的探讨IgA肾病(IgAN)肾小管间质病变与临床及病理的关系。方法分析182例IgA肾病患者的临床与病理资料。结果IgAN伴肾小管间质损害68%,其中轻度42%,中度22%,重度4%。血压升高、尿蛋白定量增加、肾功能减退是IgAN预后不良的因素,尿渗透压、尿β2-微球蛋白(β2-MG)能反映肾小管间质的损害程度。肾小球各项病理指标(肾小球病变积分、球性硬化、血管病变积分)、病理分级与肾小管间质损害程度呈平行关系。结论尿渗透压、肾小球病变积分、尿β2-MG、球性硬化、血管病变积分对肾小管间质损害的发生有显著意义。肾小管间质损害是IgAN预后不良的决定因素之一。

Objective To evaluate the correlation of renal tubulointerstitial damage with clinical and pathological changes in patients with primary IgA nephropathy. Methods The clinical and pathological data of 182 cases of primary IgA nephropathy were retrospectively studied and multivariate stepwise regression analysis methodwas used. Results The pathological data showed that 68% of all the cases were accompanied with renal tubulointerstitial damage, which included mild （42%）, moderate （ 22% ） and severe（4% ）, damage, respectively, elevation of blood pressure, increase of urinary protein and worsening of renal function were clinically poor prognostic factors of IgA nephropathy. Urine osmotic pressure and urine β2 microglobulin output revealed the degree of tubulointerstitial damage. Indicators of renal glomemlar injury （ glomemlar damage score,global sclerosis,vascular damage score） and pathological grade were parallel with the degree of tubulointerstitial damage. Conclusion Urine osmotic pressure, urine β2 microglobulin output, glomemlar damage score,global sclerosis and vascular damage score were strong indicators of renal tubulointerstitial damage. Renal tubulointerstitial damage was one of the most important factors of poor prognosis in patients with primary IgA nephropathy.