IgA肾病61例临床病理分析

CLINICO-PATHOLOGICAL FEATURES OF 61 CASES IgA NEPHROPATHY

目的:了解IgA肾病的临床、病理和免疫病理特征。方法:选择IgA肾病61例(占此阶段全部肾穿病例的42.1%);男35例,女26例,平均发病年龄为31.35±10.85岁。进行临床特点、病理变化及免疫病理等资料的回顾性分析。结果:本组病人临床多数表现为大量蛋白尿(88.5%),有水肿者占83.6%,高血压占32.8%,肉眼血尿72.1%。病理上肾小球病变除表现为新月体的发生(55.7%)外,同时伴肾小球的球性硬化、节段性硬化、球囊壁断裂等;而小管间质病变如:肾小管萎缩、间质纤维化及间质炎细胞浸润分别为88.5%、80.3%及85.2%;免疫病理多样化,其中IgA+C3+IgM及IgA+IgG+IgM+C3型的沉积较普遍。结论:IgA肾病病人临床上主要表现为大量蛋白尿及血尿;病理上具有小球、小管、间质及血管等多部位及多种多样病理改变。大量蛋白尿、IgA、IgM、C3的高表达可能在新月体的形成及发展中起重要作用。

Objective： To investigate the clinico - pathological features of IgA nephropathy. Methods：61 patients with IgA nephropathy（ accounted for 42.1% of a total series of renopuncture） ,inclu- ding 35 men and 26 women with average age of 31.35 ±10.85 were studied. Clinical, immune and patholgical features were investigated. Results： Clinically, most of the patients showed that proteinuria was noted in 88.5% ,edema in 83.6% ,hypertension in 32.8% ,gross hematuria in 72. 1%. Pathologically, there were also segmental sclerosis of glomerulus and rupture of renal capsule. Aside from crescent formation was noted in 55.7%. Tubular interstitial damage also was obse/ved. Tubular atrophy was noted in 88.5% ,interstitial fibrosis in 80. 3% ,diffuse interstitial infiltration of cells in 85.2%. Immuno - pathologically,two phenotypes were observed, including IgA ＋ IgM ＋ C3 and IgA ＋ IgM ＋ C3 ＋ IgG. Conclusion： Patients with IgA nephropathy showed more clinical manifestations and associated with various pathological changes including glomerular, tubular interstitial and vascular lesions. The High expression of proteinuria,IgA, C3,IgM in kidney may be contributed to the crescent in patients with IgA nephropathy.