IgA肾病390例临床病理分析

Clinical Presentation and Pathologic Feature of 390 Patients with IgA Nephropathy

目的：研究武汉地区IgA肾病（IgA N）的临床、病理及流行病学特点.方法：分析华中科技大学同济医学院附属协和医院1998年1月~2005年3月间肾活检诊断的IgA N 390例进行临床和病理类型分析.结果：390例IgAN发病年龄以21~40岁为高发,占59.2%（231/390）.临床表现以无症状尿检异常最常见,占198例（50.8%）,其次是肾病综合征59例（15.1%）、复发性肉眼血尿57例（14.6%）、慢性肾炎49例（12.6%）和急性肾炎25例（6.4%）.病理类型以局灶性病变为主（局灶节段硬化性肾小球肾炎、局灶节段增生性肾小球肾炎,分别为135例（34.6%）、46例（11.8%））,其次是系膜增生性肾小球肾炎158例（40.5%）,肾小球轻微病变26例（6.7%）.结论：IgA N在青壮年期发生率高,临床表现以无症状尿检异常为主,病理变化以局灶性病变（硬化和增生）为主,定期尿检对于早期发现疾病和干预治疗具有不可忽视的作用.

Objecive： To research the relationship between clinical features and histopathology types in IgA nephropathy （IgA N） in Wuhan area. Methods： 390 cases were made renal biopsy and got positive diagnosis in the Affiliated Union Hospital of Tongii Medical College in Wuhan from January 1998 to March 2005. The clinical and renal pathological features were analysed. Results： Higher incidence ofIgA N of age was 21 to 40 （59.2 %）. Asymptomatic hematuria and proteinuria was the most common clinical manifestation （50.8 %）, followed by nephrotic syndrome （15.1%）, recurrent gross hematuria （14.6 %）, chronic nephritis （12.6 %） and renal nephritis （6.4 %）. The most common pathological type was focal change： focal segmental glomerulosclerosis （FSGS, 34.6 %）, focal proliferative glomerulonephritis （FPGN, 11.8 %）, followed by mesangial proliferative glomerulonephritis （MsPGN, 40.5 %）, and glomerularminor lesion （GML, 6.7 %）. Conclusion： The high incidence ofIgA N occurs on the period ofyoungs. The most common type in clinical feature is asymptomatic hematuria and the main pathological chang is focal glomerulonephritis （sclerosis and proliferation）. Regular urinary test is important to discovery of patients with IgA N. Early diagnosis and treatment play an important role for the patients.