不同性别原发性IgA肾病随增龄的临床病理特点

Gender Differences of Age-related Clinical and Pathological Features in Primary IgA Nephropathy

目的：了解不同性别原发性IgA肾病（IgAN）患者随增龄的临床病理特点。方法：回顾性分析我科2003年1月～2006年12月经肾活栓确诊的757例原发性IgAN患者的临床病理资料，根据年龄分成四组：A组（青年组，≤24岁，n=172例）、B组（中青年组，25岁～39岁，n=318）、C组（中年组，40岁～54岁，n=189）及D组（中老年组，≥55岁，n=78），分别比较不同性别组随增龄及同一年龄段男性与女性的临床病理特点。结果：A、B、C组男性多于女性，而D组女性多于男性。男、女性原发性IgAN中肾功能中度受损（eGFR〈60 ml／min）、高血压、高甘油三酯血症的比例均与年龄有关（P〈0．05）。A组最低，男性中B、C、D组均显著高于A组（P〈0．007），而女性中仅D组显著高于A组（P〈0．007），B、C组与A组无差异。另外，B、C组中男性肾功能中度受损、高血压及高甘油三酯血症的比例均显著高于女性（P〈0．05），而A、D组均无此趋势。B、C组男性的肾小管间质病变、肾内血管病变及血管壁透明样变性程度均重于同年龄段的女性（P〈0．05），而A、D组均无此趋势。女性患者肾功能中度受损的独立相关因素有年龄、高尿酸血症、肾小管间质损害、蛋白尿〉1g／d、肾内动脉病变5个参数。男性的独立相关因素为年龄、高尿酸血症、肾小管间质损害、全球硬化这4个参数。结论：中青年及中年女性IgAN患者的临床表现、慢性化病理改变显著轻于同年龄段男性，而55岁以上及24岁以下女性多个临床病理预后指标与同年龄段男性基本一致。

Objective：To explore the gender differences of age - related clinical and pathological features in primary IgA nephropathy. Methods：The clinical and pathological data of 757 cases with IgA nephropathy between January 2003 and December 2006 were analyzed in different gender and age groups retrospectively. All patients were divided into four groups according to their age：Group A（age≤24 years, n = 172） ,Group B（aged 25-39, n = 318） ,Group C（aged 40-54, n = 189） and Group D（aged≥55, n = 78）. We compared the clinical and pathological features. Results： There were more man than woman in Group A, B and C, however there were more woman than man in Group D. The rotes of moderate renal insufficience （eGFR〈 60 ml/min/1.73 m^2） ,hypertension and hypertriglyceridemia were agerelated in different gender（P〈0.05） ,which was lowest in Group A, much higher in Group B, C and D in male and only higher in Group D in female（P 〈 0. 007）. Moreover, the rates of moderate renal insufficience, hypertension and hypertriglyceridemia of male were much higher than female in Group B and C（ P 〈 0.05）, which were not significantly different in Group A and D. The tubulointerstitial lesions, intrarenal artery wall thickening and hyaline changes of male were more severe than those of female in Group B and C（P 〈 0.05）, which had no gender difference in Group A and D. The risk factors of moderate renal insufficience in females included age, hyperuricemia, tubulointerstitial lesions, proteinuria〉 1 g/d and intrarenal artery wall thickening. The risk factors for male were age, hyperuricemia, tubulointerstitial lesions and glomerulosclerosis. Conclusion：The gender difference of IgA nephropathy was age - dependent. Several prognostic factors of male were more severe than female in young and middle - aged. However, the gender differences were not found in adolescent and eldly group.