贵州省IgA肾病临床与病理特征相关性分析

Clinical and pathological analysis of 157 IgA renopathy cases in Guizhou Province

目的研究贵州省IgA肾病(IgAN)患者的临床表现与病理类型两者之间的关系,以探讨贵州省IgAN的发病率,进一步评价肾活检在肾脏病诊治中的作用及临床意义。方法方法对730例有肾穿刺活检适应证的患者行B超介导下肾活检,并作光镜、免疫荧光、电镜检查,对其中确诊为IgA肾病者作病理及临床特点分析。结果 (1)贵州省IgAN的发病率为21.51%,占原发性肾小球病的30.60%;(2)157例IgAN患者临床表现以无症状性尿检异常最常见(29.30%),其次为血尿(24.84%)、肾病综合征(16.56%)和慢性肾炎(15.92%)。根据Lee及肾小管间质损害程度分级,IgA肾病的病理改变主要表现为Ⅲ级,其次是Ⅰ和Ⅱ级,而Ⅳ、V级所占比例小。Lee分级与肾小管间质损害度分级呈正相关(P<0.01)。Lee分级高及肾小管间质损害重者高血压的发生率高,肾功能损害重。Lee分级及肾小管间质损害程度与24 h尿蛋白定量间未发现联系(各级别间比较P>0.05)。结论高血压、持续大量蛋白尿、肾功能减退的IgAN患者病理改变重,预后差;肾活检对明确肾脏疾病的病理类型、确定有效的治疗方案及评估预后均有十分重要的意义。

Objective To study the relationship among IgA nephropathy patient＇s clinical characteristic,pathology classification in order to explore the incidence of IgAN in Guizhou Province,and to evaluate clinical significance of renal biopsy in the diagnosis and treatment of kidney disease.Methods The kidney of 730 patients were punctured under type-B ultrasonic,then reviewing was done about the clinic and laboratory indexes of 157 patients with IgAN by microscopy,immunofluorescence,electron microscopy.ResultsThe incidence of IgAN was 21.51% in Guizhou Province,accounted for 30.60% in Primary glomerular disease.The most common clinical manifestations was asymptomatic urine abnormalities（29.30%）,followed by hematuria（24.84%）,nephrotic syndrome（16.56%） and chronic glomerulonephritis（15.92%）.Lee classification takes Ⅲ grade as the core in grades.WhileⅠ and Ⅱ grade were more than ⅣandⅤ grade in proportion.Lee of IgAN grades presents positive correlation with rubule interstitial leision grades（P〈0.01）.The incidence of high blood pressure was high and kidney function damage was heavy when patients combine with higher Lee grades and TIL grades.The relation between the extent of kidney pathology damage and urine proteinwas not found（P〉0.05）.Conclusion IgAN patients with high blood pressure,constant large amount of proteinuria and drop of renal function have heavy pathology damage and bad prognosis.And renal biopsy is great significance in clearing pathological types of renal disease,identifing effective treatment programs and evaluating the prognosis.