IgA肾病肾病综合征临床病理特点及肾脏病理危险因素

Clinical and Pathological Analysis of IgA Nephropathy Patients with Nephrotic Syndrome

目的：探讨IgA肾病肾病综合征患者临床病理特点及肾脏病理损害的危险因素。方法：选择1987年～2006年经肾活检确诊IgA肾病并表现为肾病综合征的患者118例，分析其临床病理特点，按肾脏病变轻重分为A组（n=34，包括Lee氏分级Ⅰ级、Ⅱ级）、B组（n=84，Ⅲ、Ⅳ、Ⅴ级），比较两组临床指标，并多因素分析影响肾脏病理损害的危险因素。结果：A、B两组高血压分别占11．8％ vs 63．1％；肾衰竭分别占15％ vs 41．7％；A、B两组尿蛋白≥6g／24h者分别占58．8％ vs 32．1％；尿红细胞满视野分别为14．7％ vs 50％。A组高血压、肾衰竭、镜下尿红细胞满视野发生率显著低于B组（P〈0．01），尿蛋白≥6g／24h发生率显著高于B组（P〈0．01）。A组平均动脉压、血肌酐明显低于B组（P〈0．01）；而尿蛋白定量、血红蛋白显著高于B组（P〈0．05）。多因素分析显示IgA肾病肾病综合征患者肾脏病理损害重的危险因素有平均动脉压、尿蛋白〈6g／24h、镜下尿RBC〉5．0×10^7／L（0R值分别为1．048，3．227，6．578；P值分别为0．034，0．047，0．002），血红蛋白是保护性因素（OR=0.723，P=0．035）。随着平均动脉压的升高、血红蛋白的降低、镜下尿红细胞数的增多，肾脏病理损害程度加重（P〈0．01）。结论：IgA肾病肾病综合征患者临床、病理表现存在差异，高血压、血红蛋白水平、24h尿蛋白排泄量、镜下尿红细胞程度有助于判断肾脏病理损害轻重。

Objective：To study the clinical and pathological characteristics of IgA nephropathy patients with nephrotic syndrome and the clinical risk factors associated with the renal pathologic lesions. Method： 118 patients with nephrotic syndrome were collected from the inpatients who were diagnosed as IgA nephropathy by renal biopsy. The clinical and pathological features of patients were analyzed. And the clinical index of different severity of renal pathologic lesions was compared; the relationship between renal pathologic lesions and clinical factors were studied; the predicted factors were analyzed by step-wise multiple variance regression analysis. Results： The incidence of hypertension, renal failure, full field of microscopic hematuria was lower in group A than those in group B（ 11.8 % vs 63.1%, 15 % vs 41.7 %, 14.7 % vs 50 %, respectively. P 〈 0.01 ）. But the incidence of urinary protein （UP）≥6 g/24 h was higher in group A than that in group B（58.8 % vs 32.1%, P 〈 0.01 ）. Mean arterial pressure（MAP）, serum creatine （Scr） were lower in group A than those in group B（P〈0.01）,urinary protein excretion, hemoglobin were higher in group A than those in group B（ P 〈 0.01 ）. MAP, UP〈 6 g/24 h;microscopic hematuria 〉 5.0 × 10^7/L were independent predictors of the severity of renal pathologic lesion in IgA nephropathy patients with nephrotic syndrome（OR = 1. 048,3. 227,6. 578, P = 0. 034, 0. 047,0. 002. respectively. ） Hemoglobin was a favorable factor for renal pathologic lesion. Meanwhile, with the decreasing of hemoglobin, the increasing of hypertension and number of microscopic hematuria the renal pathologic lesion are more severe. Conclusion： IgA nephropathy patients with nephrotic syndrome have different clinical manifestations and pathologic lesions; patients with decreased hemoglobin, accompanied by hypertension and mass microscopic hematuria have more severe renal lesions.