210例IgA肾病肾间质血管病变的临床病理分析

The analysis of clinicopathological significance of renal interstitial vascular lesions in 210 patients with idiopathic IgA nephropathy

目的探讨肾间质血管病变在IgA肾病中的临床病理意义。方法总结本院肾内科1999年1月～2010年6月肾活检证实210例IgA肾病患者临床病理资料，分析肾血管病变与患者临床表现、病理改变之间的关系。结果210例IgA肾病中有各种。肾血管病变者71例，占33．8％，139例患者无血管病变，占66．2％。两者相比，前者高血压发生率较高（73．2％vs24．5％，P〈0．05），血肌酐水平较高[（132．5±20．8）μmol／LVS（86．4±15．2）μmol／L，P〈0．05]，肾小球滤过率较低[（59．7±9．2）mL／minVS（83．1±12．6）mL／min，P〈0．05]，两组间差异有统计学意义。在IgA肾病各亚型中血管病变发生率分别为：I型6．0％；1I型43．9％；Ⅲ型6．9％；IV型40．8％；V型93．1％。x^2检验表明其不同分布的差异有统计学意义（P〈0．05），并提示随着IgA肾病的组织病理加重，肾间质血管病变增多。结论肾间质血管病变在IgA肾病中较为常见，并与IgA肾病的临床表现及病理改变密切相关，提示肾间质血管病变是影响IgA肾病进展的重要因素。

Objectives To investigate the clinicopathological significance of renal interstitial vascular lesions in idiopathic IgA nephropathy. Methods The clinicopathological data of 210 biopsy - proven cases of idiopathic IgAN from Jan. 1999 to Jun. 2010 in our hospital was retrospectively analyzed and the relationship between renal vascular lesions and clinical manifestation and pathological features was studied. Results Amongst the 210 patients studied, 33.8 % （ 71 cases ） were with various vascular lesions, compared with other 139 cases without vascular lesions, the incidence of hypertension was higher（73.2% vs 24.5% ,P 〈0.05 ] ,the Scr was higher [ （ 132.5± 20.8 ） μmol/L vs （ 86.4 ± 15.2） μmol/L, P 〈 0.05], eGFR was lower[ （ 59.7 ± 9.2 ） ml/min vs （ 83.1 ± 12.6 ） ml/min, P 〈 0. 05], the differences had statistical significance. The distribution of renal vascular lesions in pathologi- cal subtypes of IgAN was 6.0% in I type （ 2/33 cases） ; 43.9% in II type （ 18/41 cases ） ; 6.9% in II1 type （4/59 cases） ,40.8 % in IV type （20/49 cases ） ; 93.1% in V type （27/29 cases ）. Chi -square test showed the difference of vascular lesions in different types of IgAN had statistical significance （ P 〈 0.05 ）, and indicate the vascu- lar lesions increased as the exacerbation of pathological changes. Conclusions Renal vascular lesions were com- mon in patients with idiopathic IgA nephropathy and were closely related with the clinical manifestation and pathological features. It was suggested that renal vascular lesions can be an important effecting factor on the progression of IgA nephropathy.