强直性脊柱炎相关IgA肾病临床病理分析

Cfinicopathological analysis of IgA nephropathy associated with ankylosing spondyfitis

目的了解强直性脊柱炎（AS）相关IgA肾病的临床病理特点。方法自1997年1月至2006年12月10年间在北京协和医院接受肾活检确诊为IgA肾病的AS患者10例，回顾性分析其临床及病理特点。结果男性9例，女性l例，平均年龄（28．6＋6．8）岁（16～53岁）。4例患者表现为无症状镜下血尿；6例表现反复血尿合并蛋白尿，其中2例有发作性肉眼血尿。平均尿蛋白量（24h）为（1．56±1．53）g（0．02-5．26g）。2例患者有血压升高。所有患者的血肌酐水平均在正常范围。光镜下，8例患者呈轻度系膜细胞增生，IgA肾病Lee氏分级均为Ⅰ或Ⅱ级；另外2例呈中重度系膜增生性改变，IgA肾病Lee氏分级分别为Ⅲ级和Ⅵ级。结论AS相关IgA肾病临床表现为隐匿性肾炎或慢性肾小球肾炎，病理改变以轻度系膜增生为主。

Objective To elucidate the clinical and pathologic characteristics of IgA nephropathy associated with ankylosing spondylitis（AS ）. Methods Clinical and pathologic data of l0 patients suffered from IgA nephropathy associated with AS were reviewed. They were admitted to our hospital from 1997 to 2006 and diagnosed by renal biopsy. Results The average age of nine male and one female patients was （28.6±6.8） years old. Four patients presented with asymptomatic hematuria, and six with hematuria and proteinuria. All the patients suffered from microhematuria and two from macrohematuria. The average 24-hour proteinuria was （1.56 ± 1.53） g. Two had hypertension. Serum creatinine levels of all the cases were normal. Light microscopy examination showed that eight patients were mild mesangial proliferation with Lee＇s classification grade Ⅰ or grade Ⅱ, and the other two were moderate to severe mesangial proliferation with grade Ⅲ or grade Ⅵ. Conclusion Mild mesangioproliferative IgA glomerulonephritis may be the major morphological pattern in AS patients with renal involvement.