不同性别成人IgA肾病患者临床特征

Gender differences of clinical features in adult primary IgA nephropathy

目的了解不同性别成人原发性IgA肾病（IgAnephropathy，IgAN）患者的临床特征。方法选择我科1996年3月至2009年11月经肾活检确诊为kAN的成人患者192例，对比分析男性和女性患者各临床表现和病理积分特点。结果成人IgAN患者中，不同性别患者的病程、发病年龄、血胆固醇、清蛋白、血IgA、血C3、尿红细胞计数和估算肾小球滤过率值的差异无统计学意义，但男性收缩压、舒张压、血肌酐、尿素氮、血尿酸及24h尿蛋白定量明显高于女性，差异显著。男性高血压、高尿酸血症、高三酰甘油血症、24h尿蛋白定量〉1g的比例显著高于女性。男女患者的肾小球积分、肾小管间质积分、血管积分及慢性病变、活动性病变积分差异均无统计学意义。肾功能中度损伤的独立危险因素为高尿酸血症（r=9．146，95．0％CI：2．322-36．026，P〈0．01）、总积分（r=2．772，95．0％CI：1．709～4．496，P〈0．01）、肾小球积分（r=0．522，95．0％CI：0．287-0．952，P〈0．05）。结论成人IgAN患者肾活检时男女患者间的肾功能及。肾脏病理改变并无明显差异，但男性患者相关临床病变重，血压、血肌酐、血尿酸及24h尿蛋白定量高，需积极干预延缓其进展。

Objective To investigate the gender differences of clinical features in adult primary IgA nephropathy. Methods The clinical and pathological data of 192 patients with adult primary IgA nephropathy diagnosed by renal biopsy from March 1996 to November 2009 were collected and analyzed in different gender. Results There were no significant differences in disease courses, age of onset, cholesterol, serum albumin, serum IgA level, serum （23 level, urine RBC count and eGFR between male and female. However, there were much higher systolic pressure, diastolic pressure, serum creatinine, blood urea nitrogen, serum uric acid and 24 h urinary protein excretion rate in male patients than in female. The incidence of hypertension,hyperuricemia, hypertriglyceridemia and proteinuria≥1 g/d in males was significantly higher than in females. There was no statistically significant difference in glomerular lesions, interstitial and tubular injury, arteriosclerosis score, chronic pathological lesions and active lesions between males and females. The independent risk factors of moderate renal insufficiency were hyperuricemia（ r = 9. 146, 95.0 % CI： 2. 322 - 36. 026, P 〈 0. （11） total pathological scores （r = 2. 772,95. 0%CI：1. 709-4. 496, P〈0.01） and glomerular lesions（r= 0.522,95.0%CI：11.287- 0. 952,P〈0. 115）. Conclusions There are no significant differences in eGFR and renal pathological scores between adult male and female patients with primary IgA nephropathy when diagnosed by renal biopsy. While some of the risk factors such as blood pressure, serum creatinine, serum uric acid and 24 h urinary protein excretion rate are more serious in male patients. Active treatment should be taken to delay the progression of male patients with IgA nephropathy.